Most Relevant Information
Provider Data
| NPI Number: | 1003565664 |
| Provider Name: | GRACE WIRYAWAN NP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 95019521 |
Most Important Dates
| Enumeration Date: | 03/21/2022 |
| Last Updated: | 03/21/2022 |
Provider Practice Location
3030 W BALL RD
ANAHEIM
CA
928043897
Practice Location Phone/Fax
| Phone: | 6268729844 |
| Fax: |
Provider Mailing Location
500 N ATLANTIC BLVD APT 302
ALHAMBRA
CA
918012230
Provider Mailing Phone/Fax
| Phone: | 6268729844 |
| Fax: |