Healthcare Provider Details

I. General information

NPI: 1386992428
Provider Name (Legal Business Name): GRACEFULL BIRTHING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 W SUNSET BLVD #105
LOS ANGELES CA
90026-2167
US

IV. Provider business mailing address

2815 W SUNSET BLVD #105
LOS ANGELES CA
90026-2167
US

V. Phone/Fax

Practice location:
  • Phone: 978-544-3551
  • Fax: 480-275-3707
Mailing address:
  • Phone: 323-963-3868
  • Fax: 323-430-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number215
License Number StateCA

VIII. Authorized Official

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