Provider Demographics
NPI:1346124013
Name:HOLIDAY, GRACIE
Entity type:Individual
Prefix:
First Name:GRACIE
Middle Name:
Last Name:HOLIDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WILLOW
Other - Middle Name:
Other - Last Name:HOLIDAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3522 PERLITA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1934
Mailing Address - Country:US
Mailing Address - Phone:213-359-5375
Mailing Address - Fax:
Practice Address - Street 1:5651 N ARLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-4247
Practice Address - Country:US
Practice Address - Phone:213-359-5375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula