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NPI Code Detail

MEDICARE: MIRIAM P. GRITZEWSKY B.A.

MEDICARE: MIRIAM P. GRITZEWSKY B.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1295865053
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRIAM P. GRITZEWSKY B.A.
Provider Business Mailing Address
First Line : 760 MOUNTAIN VIEW ST
Second Line :
City : ALTADENA
State : CA
Zip : 91001-4925
Country : US
Telephone Number : 626-798-6793
Fax Number :
Provider Business Practice Location Address
First Line : 867 N FAIR OAKS AVE
Second Line :
City : PASADENA
State : CA
Zip : 91103-3050
Country : US
Telephone Number : 626-798-6793
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/21/2022

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