Provider Demographics
NPI:1841957933
Name:GRACE HEALTH AND WELLNESS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GRACE HEALTH AND WELLNESS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-820-0126
Mailing Address - Street 1:5301 NORRIS CANYON ROAD
Mailing Address - Street 2:#220
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-820-0126
Mailing Address - Fax:925-820-8183
Practice Address - Street 1:5301 NORRIS CANYON ROAD
Practice Address - Street 2:#220
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-820-0126
Practice Address - Fax:925-820-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty