Provider Demographics
NPI:1982963435
Name:JUAREZ, GRACE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:M
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:MADRID
Other - Last Name:MITU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9777 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 911
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1910
Mailing Address - Country:US
Mailing Address - Phone:424-333-0140
Mailing Address - Fax:
Practice Address - Street 1:9777 WILSHIRE BLVD
Practice Address - Street 2:SUITE 911
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1910
Practice Address - Country:US
Practice Address - Phone:424-333-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1231102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry