Healthcare Provider Details

I. General information

NPI: 1164511960
Provider Name (Legal Business Name): RONALD SELWYN GRUSD M.D. DABR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 WILSHIRE BLVD STE 105
BEVERLY HILLS CA
90211-2919
US

IV. Provider business mailing address

8641 WILSHIRE BLVD STE 105
BEVERLY HILLS CA
90211-2919
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-8678
  • Fax:
Mailing address:
  • Phone: 310-289-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA32707
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA32707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: