Provider Demographics
NPI:1295232791
Name:GRACIA, AMANDA (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:GRACIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 BUSINESS PARK CT STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9010
Mailing Address - Country:US
Mailing Address - Phone:702-844-8143
Mailing Address - Fax:702-844-8145
Practice Address - Street 1:2831 BUSINESS PARK CT STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9010
Practice Address - Country:US
Practice Address - Phone:702-844-8143
Practice Address - Fax:702-844-8145
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine