MEDICARE: GRACE ALDEN LESCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	L27973006153982	OTHER	NJ	DRIVER'S LICENSE

General Provider Information

NPI Number	:	1922731439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ALDEN LESCE

Provider Business Mailing Address
First Line	:	715 S NORMANDIE AVE APT 609
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-2225
Country	:	US
Telephone Number	:	908-868-9278
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 S NORMANDIE AVE APT 609
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-2225
Country	:	US
Telephone Number	:	908-868-9278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2022
Last Update Date	:	07/03/2022

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Directions to “ GRACE ALDEN LESCE ” Practice Location

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