Provider Demographics
NPI:1598470254
Name:GITHUI, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GITHUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 E PHILLIPS BLVD UNIT 11
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-7553
Mailing Address - Country:US
Mailing Address - Phone:832-447-5392
Mailing Address - Fax:
Practice Address - Street 1:961 E PHILLIPS BLVD UNIT 11
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7553
Practice Address - Country:US
Practice Address - Phone:832-447-5392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN729320164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse