Provider Demographics
NPI:1467187914
Name:WEBER, GRACE L (LM, CPM, MS)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:L
Last Name:WEBER
Suffix:
Gender:
Credentials:LM, CPM, MS
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM, CPM, MS
Mailing Address - Street 1:619 CHERRY AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-8304
Mailing Address - Country:US
Mailing Address - Phone:845-750-1921
Mailing Address - Fax:
Practice Address - Street 1:619 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-2045
Practice Address - Country:US
Practice Address - Phone:845-750-1921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program