Provider Demographics
NPI:1508400219
Name:GRACE OROPESA LLC
Entity Type:Organization
Organization Name:GRACE OROPESA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRAZIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:OROPESA
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-918-2820
Mailing Address - Street 1:12824 NW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12824 NW 21ST ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2534
Practice Address - Country:US
Practice Address - Phone:954-918-2820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000176264Medicaid