Provider Demographics
NPI:1770546871
Name:GRACIA, FRANCISCO (MD)
Entity type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:
Last Name:GRACIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 4TH AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4410
Mailing Address - Country:US
Mailing Address - Phone:619-425-5184
Mailing Address - Fax:619-425-7472
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4410
Practice Address - Country:US
Practice Address - Phone:619-425-5184
Practice Address - Fax:619-425-7472
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33844174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA33844CMedicare ID - Type Unspecified