| Global Grace Medical Services Inc | |
|
2204 Torrance Blvd, Suite 102 Torrance CA 90501-0502 | |
| (424) 488-2030 | |
| (424) 488-2202 |
| Full Name | Global Grace Medical Services Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2204 Torrance Blvd,, Torrance, California |
| Authorized Official Name and Position | Grace Olubukola Adeagbo (CEO) |
| Authorized Official Contact | 3233658154 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Global Grace Medical Services Inc 2204 Torrance Blvd, Suite 102 Torrance CA 90501-0502 Ph: (424) 488-2030 | Global Grace Medical Services Inc 2204 Torrance Blvd, Suite 102 Torrance CA 90501-0502 Ph: (424) 488-2030 |
| NPI Number | 1306495908 |
|---|---|
| Provider Enumeration Date | 09/06/2019 |
| Last Update Date | 05/14/2021 |
| Medicare PECOS PAC ID | 9638501521 |
|---|---|
| Medicare Enrollment ID | O20191114001479 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306495908 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Bambi Lynn Nickelberry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942383740 PECOS PAC ID: 3476553140 Enrollment ID: I20070102000407 |
| Provider Name | Grace Adeagbo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992986731 PECOS PAC ID: 2668677402 Enrollment ID: I20170112000909 |
| Provider Name | Heidi Regenass |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1225258965 PECOS PAC ID: 3274704176 Enrollment ID: I20200427000698 |
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