Gracevine Healthcare SVCS a Professnal Nursing Corp

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

GRACEVINE HEALTHCARE SVCS A PROFESSNAL NURSING CORP

Practice address

473 E Carnegie Dr Ste 200
San Bernardino, CA 92408-4201

Phone

(909) 743-1300

NPI assigned

Aug 24, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Oluwayemisi Daramola

Title

Owner

Phone

(909) 743-1300

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1255050084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "473 E CARNEGIE DR",
            "address_2": "STE 200",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92408",
            "telephone_number": "909-743-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 E CARNEGIE DR STE 200",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924084201",
            "telephone_number": "909-743-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEVINE HEALTHCARE SVCS A PROFESSNAL NURSING CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-24",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "DARAMOLA",
        "authorized_official_first_name": "OLUWAYEMISI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-743-1300"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madeline Gould
• Shannon Marie Goulmassian, RN, CNS
• Brenda Alejandra Govea
• Nadine Grace-Abraham, MD
• Del Grace
• Emely Gracia
• Roxanna Belem Gracia
• Janet Graciano
• Grads Inc.
• Arianna Graham

• Family Nurse Practitioner in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.