Individual
GRACIE JAE ROATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
760 S AUBURN ST STE C2, GRASS VALLEY, CA 95945-4318
(530) 889-7240
Mailing address
760 S AUBURN ST STE C2, GRASS VALLEY, CA 95945-4318
(530) 889-7240
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
OQP
CA
Other
Enumeration date
02/07/2025
Last updated
04/12/2025
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