Provider Demographics
NPI:1689012908
Name:TASSA, GRACE MORGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:MORGAN
Last Name:TASSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5806
Mailing Address - Country:US
Mailing Address - Phone:310-828-4530
Mailing Address - Fax:
Practice Address - Street 1:881 ALMA REAL DR STE 101
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3792
Practice Address - Country:US
Practice Address - Phone:310-829-8923
Practice Address - Fax:424-212-5936
Is Sole Proprietor?:No
Enumeration Date:2013-06-08
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA141472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine