Grace Medical and Wellness Clinic

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GRACE MEDICAL AND WELLNESS CLINIC

Doing business as

Grace Medical Spa

Practice address

6900 Brockton Ave Ste 200
Riverside, CA 92506-3818

Phone

(909) 664-4634

NPI assigned

Aug 11, 2023

Last updated

Dec 8, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Phillip Alhir

Title

Coo

Phone

(909) 664-4634

Specialties & licenses 1

Addresses

Other names 1

• Grace Medical Spa Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angelina Abila

  • Family Nurse Practitioner
  • Riverside, CA
  • NPI 1720733967
  Medicare reassignment Care Compare group NPD
• Yas Casey

  • Internal Medicine Physician
  • Loma Linda, CA
  • NPI 1336568971
  Medicare reassignment Care Compare group NPD
• Melanchton Atiga Mangoba, M.D.

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1376605717
  Medicare reassignment Care Compare group NPD
• Anna Maria Wilson, MSN, ACNP

  • Acute Care Nurse Practitioner
  • Moreno Valley, CA
  • NPI 1326073263
  Medicare reassignment Care Compare group NPD
• Eunjin Lee

  • Primary Care Nurse Practitioner
  • Riverside, CA
  • NPI 1932059250
  Medicare reassignment Care Compare group
• Mousa Matar, M.D.

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1992116982
  Medicare reassignment NPD
• Ruth Ramirez, NP

  • Family Nurse Practitioner
  • Riverside, CA
  • NPI 1710766704
  Medicare reassignment NPD
• Luther Mangoba, M.D.

  • Family Medicine Physician
  • Riverside, CA
  • NPI 1528041894
  NPD (past)

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

{
    "created_epoch": "1691712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701993600000",
    "number": "1689357030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 BROCKTON AVE STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063818",
            "telephone_number": "909-664-4634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 BROCKTON AVE STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063818",
            "telephone_number": "909-664-4634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE MEDICAL AND WELLNESS CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-11",
        "last_updated": "2023-12-08",
        "certification_date": "2023-12-08",
        "status": "A",
        "authorized_official_last_name": "ALHIR",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "909-664-4634"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grace Medical Spa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jenna Goytia
• Jocelin Gozalez Sepulveda
• Carol Gozzip, PHARM D
• Christopher Michael Grable, FNP-C
• Grace Home Health Services, Inc. (Grace Home Health Services)
• Theresa Grace, BA
• Jessica Rosario Gracia
• Jonathan Eduardo Gracian
• Genevieve Gradilla, LVN
• Kiana Grady

• Internal Medicine Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.