MEDICARE: AJITA GREWAL M.D.

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
1	207W00000X	Ophthalmology Physician	A061389	CA

General Provider Information

NPI Number	:	1669491486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJITA GREWAL M.D.

Provider Business Mailing Address
First Line	:	762 ALTOS OAKS DR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-5434
Country	:	US
Telephone Number	:	650-948-9123
Fax Number	:	650-948-0563

Provider Business Practice Location Address
First Line	:	762 ALTOS OAKS DR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94024-5434
Country	:	US
Telephone Number	:	650-948-9123
Fax Number	:	650-948-0563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	06/09/2015

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