Provider Demographics
NPI:1245479278
Name:GROTE, JOSCELYN MICHAELA (LM, CPM)
Entity type:Individual
Prefix:MS
First Name:JOSCELYN
Middle Name:MICHAELA
Last Name:GROTE
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 ALMAR AVE
Mailing Address - Street 2:SUITE 'C' PMB #415
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5875
Mailing Address - Country:US
Mailing Address - Phone:831-425-4420
Mailing Address - Fax:
Practice Address - Street 1:406 MISSION ST
Practice Address - Street 2:SUITE 'E'
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3748
Practice Address - Country:US
Practice Address - Phone:831-425-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife