Healthcare Provider Details

I. General information

NPI: 1982240461
Provider Name (Legal Business Name): GRACE NATALIE MCMANUS AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 12/08/2021
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 ARIZONA AVE
SANTA MONICA CA
90404-1337
US

IV. Provider business mailing address

11645 WILSHIRE BLVD STE 600
LOS ANGELES CA
90025-6807
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8701
  • Fax: 310-477-7281
Mailing address:
  • Phone: 310-909-0180
  • Fax: 310-919-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number8354
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: