Provider Demographics
NPI:1477828150
Name:GOROSPE, MARY GRACE F (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY GRACE
Middle Name:F
Last Name:GOROSPE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1300 ETHAN WAY STE 600
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2296
Mailing Address - Country:US
Mailing Address - Phone:916-786-7498
Mailing Address - Fax:916-786-2719
Practice Address - Street 1:5 MEDICAL PLAZA DR STE 190
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2867
Practice Address - Country:US
Practice Address - Phone:916-786-7498
Practice Address - Fax:916-786-2715
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2021-07-09
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Provider Licenses
StateLicense IDTaxonomies
CA52728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant