Provider Demographics
NPI:1750603494
Name:OUCHIDA, GRACE S (LAC)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:S
Last Name:OUCHIDA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:414 POWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3420
Mailing Address - Country:US
Mailing Address - Phone:707-206-6895
Mailing Address - Fax:
Practice Address - Street 1:414 POWELL AVE
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3420
Practice Address - Country:US
Practice Address - Phone:707-206-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13256171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist