| Yolanda T Grady, M.d. Inc | |
|
13768 Roswell Ave Suite 202 Chino CA 91710-1401 | |
| (909) 628-4205 | |
| (909) 628-4875 |
| Full Name | Yolanda T Grady, M.d. Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 13768 Roswell Ave, Chino, California |
| Authorized Official Name and Position | Yolanda Grady (PRESIDENT) |
| Authorized Official Contact | 9096284205 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Yolanda T Grady, M.d. Inc 13768 Roswell Ave Suite 202 Chino CA 91710-1401 Ph: (909) 628-4205 | Yolanda T Grady, M.d. Inc 13768 Roswell Ave Suite 202 Chino CA 91710-1401 Ph: (909) 628-4205 |
| NPI Number | 1952497513 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 05/29/2012 |
| Medicare PECOS PAC ID | 8921064080 |
|---|---|
| Medicare Enrollment ID | O20041209000730 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952497513 | NPI | - | NPPES |
| ZZZ31642Z | Other | CA | PTAN |
| P00418455 | Other | CA | MEDICARE RAILROAD PTAN |
| 00A536730 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Yolanda Tomas Grady |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1235135518 PECOS PAC ID: 4183680242 Enrollment ID: I20041213000221 |
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