Provider Demographics
NPI:1639568694
Name:JUMA, GRACE VORCE (LAC, RN)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:VORCE
Last Name:JUMA
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 W 137TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6528
Mailing Address - Country:US
Mailing Address - Phone:310-936-1086
Mailing Address - Fax:
Practice Address - Street 1:5023 W 137TH ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6528
Practice Address - Country:US
Practice Address - Phone:310-936-1086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8630171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist