Provider Demographics
NPI:1669126348
Name:BEOUGHER, GRACE (LM, CPM)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:BEOUGHER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:SALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1018 RANGER RD
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-8213
Mailing Address - Country:US
Mailing Address - Phone:760-310-2324
Mailing Address - Fax:
Practice Address - Street 1:1018 RANGER RD
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-8213
Practice Address - Country:US
Practice Address - Phone:760-310-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA665176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty