| Divine Grace Medical Clinic | |
|
17150 Norwalk Blvd Ste 104 Cerritos CA 90703-2751 | |
| (562) 303-6662 | |
| Not Available |
| Full Name | Divine Grace Medical Clinic |
|---|---|
| Speciality | Internal Medicine |
| Location | 17150 Norwalk Blvd Ste 104, Cerritos, California |
| Authorized Official Name and Position | Mary Eppie Porciuncula Gonzales (CEO) |
| Authorized Official Contact | 5624741605 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Grace Medical Clinic 17150 Norwalk Blvd Ste 104 Cerritos CA 90703-2751 Ph: (562) 474-1605 | Divine Grace Medical Clinic 17150 Norwalk Blvd Ste 104 Cerritos CA 90703-2751 Ph: (562) 303-6662 |
| NPI Number | 1447729272 |
|---|---|
| Provider Enumeration Date | 11/22/2018 |
| Last Update Date | 06/01/2020 |
| Medicare PECOS PAC ID | 6103163829 |
|---|---|
| Medicare Enrollment ID | O20190202000188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447729272 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Mary Eppie P Gonzales |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649231739 PECOS PAC ID: 6901820463 Enrollment ID: I20060123001061 |
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