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DIVINE GRACE MEDICAL CLINIC
NPI 1447729272
Internal Medicine in Cerritos, CA

Active since November 22, 2018CLIA 05D2164876 · Waiver
17150 NORWALK BLVD STE 104, CERRITOS, CA 90703(562) 303-6662 Get Directions Write a Review

NPPES record last updated: June 1, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 1, 2020, Dec 6, 2018, Nov 22, 2018 (3 updates tracked since 2018).

About Divine Grace Medical Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIVINE GRACE MEDICAL CLINIC (NPI 1447729272) is a healthcare organization registered as an internal medicine in Cerritos, California and active in the NPI registry since November 2018. The organization holds a CLIA Waiver certificate valid through April 14, 2027 and lists Mary Eppie Porciuncula Gonzales, Ceo, as its authorized official.

NPPES Registry Identity

NPI1447729272
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameGONZALES MEDICAL CORPORATION
Location Address17150 NORWALK BLVD STE 104Cerritos, CA 90703-2751
Mailing Address17150 Norwalk Blvd Ste 104Cerritos, CA 90703-2751 · (562) 474-1605 · Fax (562) 444-0456
Phone(562) 303-6662
Organization SubpartNo
Authorized OfficialMary Eppie Porciuncula GonzalesCeo · (562) 474-1605
Enumeration DateNovember 22, 2018
Last NPPES UpdateJune 1, 20203 updates tracked since enumeration
NPPES CertifiedJune 1, 2020
✔ NPI 1447729272 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
17150 NORWALK BLVD STE 104, Cerritos, CA 90703
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Other Names 1

Doing Business AsDivine Grace Medical Clinic

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2164876

Gonzales Medical Corporation Dba Divine Grace Medical Clinic · Cerritos, CA
Active · expires Apr 14, 2027
CLIA Number05D2164876
Laboratory TypePhysician Office
Certificate Effective DateApril 15, 2025
Certificate Expiration DateApril 14, 2027
Laboratory DirectorMary Eppie P. Gonzales
Laboratory Phone(562) 474-1605
Laboratory LocationGonzales Medical Corporation Dba Divine Grace Medical Clinic17150 Norwalk Boulevard, Suite 104, Cerritos, CA 90703
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MARY EPPIE PORCIUNCULA GONZALES M.D.
Internal Medicine
17150 NORWALK BLVD STE 104
CERRITOS, CA 90703
Los Angeles County (562) 474-1605

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Gonzales Medical Corporation's NPI number?

The NPI number for Gonzales Medical Corporation is 1447729272. It was assigned to this organization in the NPPES registry on November 22, 2018. The provider is doing business as Divine Grace Medical Clinic.

Where is Gonzales Medical Corporation located?

Gonzales Medical Corporation is located at 17150 Norwalk Blvd Ste 104, Cerritos, CA 90703. The listed phone number is (562) 303-6662.

What is Gonzales Medical Corporation's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Gonzales Medical Corporation hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2164876) is associated with this NPI, valid through April 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Gonzales Medical Corporation was last updated on June 1, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.