Healthcare Provider Details

I. General information

NPI: 1720915390
Provider Name (Legal Business Name): GRACIELLA NOEL BAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 E MAIN ST STE 101
VENTURA CA
93003-2624
US

IV. Provider business mailing address

10882 CARLOS ST
VENTURA CA
93004-1297
US

V. Phone/Fax

Practice location:
  • Phone: 805-948-2229
  • Fax: 805-652-5384
Mailing address:
  • Phone: 661-904-5560
  • Fax: 805-652-5384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-19902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: