Mira Shanks Gracer | Los Angeles, CA • PECOS Search

Mira Shanks Gracer

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

1200 N State St, Los Angeles, CA 90033

PECOS Enrollment

Based on the most recent information from CMS, provider Mira Shanks Gracer does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1578926325
Provider Type
Individual
Full Name
Gracer, Mira Shanks
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
3/30/2016
Last Updated
7/23/2018

Contact Information

Practice Location

1200 N State St, Los Angeles, CA 90033

Unlisted Fax

Mailing Location

1200 N State St, Los Angeles, CA 90033-1029

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License A148239 California