Active NPI
Grace Mark Dasovich, M.D.
- Pediatrics Physician
- Orange, CA
National Provider Identifier
1811375280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A149508
- Practice address
- 505 S Main St Ste 505
Orange, CA 92868-4509 - Phone
- (714) 456-5631
- NPI assigned
- May 18, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A149508 | CA | Primary |
Addresses
Primary practice location
505 S Main St Ste 505
Orange, CA 92868-4509
Mailing address
505 S Main St Ste 505
Orange, CA 92868-4509
Phone (714) 456-5631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A149508 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543881600000",
"number": "1811375280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 S MAIN ST STE 505",
"city": "ORANGE",
"state": "CA",
"postal_code": "928684509",
"telephone_number": "714-456-5631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 S MAIN ST STE 505",
"city": "ORANGE",
"state": "CA",
"postal_code": "928684509",
"telephone_number": "714-456-5631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DASOVICH",
"first_name": "GRACE",
"middle_name": "MARK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-05-18",
"last_updated": "2018-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A149508",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.