Provider Demographics
NPI:1770697492
Name:GRACE, ANA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:ANA
Middle Name:MARIA
Last Name:GRACE
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 1:147 E HOLLY ST APT 101
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3944
Mailing Address - Country:US
Mailing Address - Phone:949-278-4763
Mailing Address - Fax:
Practice Address - Street 1:707 S. GARFIELD AVE SUITE B002
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:323-260-5825
Practice Address - Fax:323-881-8626
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA753722085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA75372AMedicare PIN
CAW15436AMedicare PIN
CAI29743Medicare UPIN
CAWA75372BMedicare PIN
CAW15436Medicare PIN