Healthcare Provider Details

I. General information

NPI: 1639093693
Provider Name (Legal Business Name): ANTHONY RAY GRIFFITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3428 MILLBURY AVE
BALDWIN PARK CA
91706-5441
US

IV. Provider business mailing address

3428 MILLBURY AVE
BALDWIN PARK CA
91706-5441
US

V. Phone/Fax

Practice location:
  • Phone: 626-683-8536
  • Fax: 626-683-8236
Mailing address:
  • Phone: 626-683-8536
  • Fax: 626-683-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number54967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: