Healthcare Provider Details

I. General information

NPI: 1588637193
Provider Name (Legal Business Name): RICHARD GRENIER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8078 E. SANTA ANA CANYON RD
ANAHEIM HILLS CA
92835
US

IV. Provider business mailing address

8078 E. SANTA ANA CANYON RD
ANAHEIM HILLS CA
92835
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-2900
  • Fax: 714-279-7501
Mailing address:
  • Phone: 714-974-2900
  • Fax: 714-279-7501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: