Provider Demographics
NPI:1740938802
Name:MCGUIRK, GRACE TESSA (RD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:TESSA
Last Name:MCGUIRK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2271 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3746
Mailing Address - Country:US
Mailing Address - Phone:201-914-2709
Mailing Address - Fax:
Practice Address - Street 1:2271 EMERALD ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3746
Practice Address - Country:US
Practice Address - Phone:201-914-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered