Provider Demographics
NPI:1528574225
Name:BAUER, GRACE CHENG
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:CHENG
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 SCHILLER ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1335
Mailing Address - Country:US
Mailing Address - Phone:415-378-5629
Mailing Address - Fax:
Practice Address - Street 1:2425 GEARY BLVD LBBY RM108
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3358
Practice Address - Country:US
Practice Address - Phone:415-833-3495
Practice Address - Fax:415-833-8937
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000434367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered