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NPI Code Detail

MEDICARE: MS. JESSICA BETH LIFSHUTZ-GRINBERG CPO

MEDICARE: MS. JESSICA BETH LIFSHUTZ-GRINBERG CPO
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
1224P00000XProsthetist1667VA
2222Z00000XOrthotist1667VA

General Provider Information

NPI Number : 1942419544
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA BETH LIFSHUTZ-GRINBERG CPO
Provider Business Mailing Address
First Line : PO BOX 1738
Second Line :
City : MENDOCINO
State : CA
Zip : 95460-1738
Country : US
Telephone Number : 707-937-6267
Fax Number : 707-937-1967
Provider Business Practice Location Address
First Line : 84 MADRONE ST
Second Line :
City : WILLITS
State : CA
Zip : 95490-4249
Country : US
Telephone Number : 707-937-3003
Fax Number : 707-937-6267
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 09/20/2018

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