Provider Demographics
NPI:1437824836
Name:GRICE, CEDAR MARIN (NP)
Entity Type:Individual
Prefix:
First Name:CEDAR
Middle Name:MARIN
Last Name:GRICE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2633
Mailing Address - Country:US
Mailing Address - Phone:805-705-0642
Mailing Address - Fax:
Practice Address - Street 1:7070 HOLLISTER AVE STE 103
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-2895
Practice Address - Country:US
Practice Address - Phone:805-324-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily