Provider Demographics
NPI:1447046883
Name:GRACE MOBILE MEDICAL GROUP
Entity type:Organization
Organization Name:GRACE MOBILE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:T
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-245-1414
Mailing Address - Street 1:17315 STUDEBAKER RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2508
Mailing Address - Country:US
Mailing Address - Phone:310-295-6492
Mailing Address - Fax:310-295-6542
Practice Address - Street 1:17315 STUDEBAKER RD STE 204
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2508
Practice Address - Country:US
Practice Address - Phone:310-295-6492
Practice Address - Fax:310-295-6542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty