MEDICARE: GRACE WEST

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	374J00000X	Doula

General Provider Information

NPI Number	:	1811873391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE WEST

Provider Business Mailing Address
First Line	:	828 14TH ST APT 9
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-1743
Country	:	US
Telephone Number	:	339-368-1359
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 14TH ST APT 9
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-1743
Country	:	US
Telephone Number	:	339-368-1359
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	08/18/2025

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Directions to “ GRACE WEST ” Practice Location

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