MEDICARE: GRACEFULL BIRTHING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	215	CA

General Provider Information

NPI Number	:	1386992428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEFULL BIRTHING INC

Provider Business Mailing Address
First Line	:	2815 W SUNSET BLVD
Second Line	:	#105
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2167
Country	:	US
Telephone Number	:	323-963-3868
Fax Number	:	323-430-8054

Provider Business Practice Location Address
First Line	:	2815 W SUNSET BLVD
Second Line	:	#105
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2167
Country	:	US
Telephone Number	:	978-544-3551
Fax Number	:	480-275-3707

Authorized Official
Title or Position	:	MIDWIFE AND FOUNDER
Name	:	ELIZABETH BACHNER
Credential	:	LM #215, CPM, L.A.C.
Telephone Number	:	323-963-3868

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	05/01/2015

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