Healthcare Provider Details

I. General information

NPI: 1881558831
Provider Name (Legal Business Name): GRACE STANLEY EMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 LARRABEE ST APT 1315
WEST HOLLYWOOD CA
90069-4525
US

IV. Provider business mailing address

840 LARRABEE ST APT 1315
WEST HOLLYWOOD CA
90069-4525
US

V. Phone/Fax

Practice location:
  • Phone: 213-595-0868
  • Fax:
Mailing address:
  • Phone: 213-595-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE147744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: