Healthcare Provider Details

I. General information

NPI: 1699974204
Provider Name (Legal Business Name): INESSA GRINBERG M.D. PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 WILSHIRE BLVD SUITE 520
BEVERLY HILLS CA
90211-3122
US

IV. Provider business mailing address

8530 WILSHIRE BLVD SUITE 520
BEVERLY HILLS CA
90211-3122
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-0770
  • Fax: 310-854-0440
Mailing address:
  • Phone: 310-854-0770
  • Fax: 310-854-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA108336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: