Healthcare Provider Details

I. General information

NPI: 1396659231
Provider Name (Legal Business Name): MY BODY MY TEMPLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12141 CENTRALIA ST UNIT 204
LAKEWOOD CA
90715-1515
US

IV. Provider business mailing address

12141 CENTRALIA ST UNIT 204
LAKEWOOD CA
90715-1515
US

V. Phone/Fax

Practice location:
  • Phone: 213-851-0164
  • Fax:
Mailing address:
  • Phone: 213-851-0164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: AKEYVA GRAY
Title or Position: CEO
Credential:
Phone: 323-393-7848