Healthcare Provider Details

I. General information

NPI: 1568119212
Provider Name (Legal Business Name): GRACE STEPANOVA LM, CPM, NTP, M-RHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 VISTOSA ST
DAVIS CA
95618-7120
US

IV. Provider business mailing address

4115 VISTOSA ST
DAVIS CA
95618-7120
US

V. Phone/Fax

Practice location:
  • Phone: 530-574-1696
  • Fax:
Mailing address:
  • Phone: 530-574-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: