Provider Information for 1699115683
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Mrs. GRACIELA RAYA WANGSNES
Sex: Female
NPI: 1699115683
Last Updated: 2024-09-06
Certification Date: 2024-09-06
Certification Date: 2024-09-06
Details
| Name | Value | ||||||||||||||||
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| NPI | 1699115683 | ||||||||||||||||
| Enumeration Date | 2013-07-05 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 22625 FRANKLIN ST GRAND TERRACE, CA 92313-5704 United States Phone: 909-953-0392 | Fax:909-824-0173 | ||||||||||||||||
| Primary Practice Address | 22625 FRANKLIN ST GRAND TERRACE, CA 92313-5704 United States Phone: 909-953-0392 | Fax: | ||||||||||||||||
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