Healthcare Provider Details

I. General information

NPI: 1790849503
Provider Name (Legal Business Name): VLADIMIR GRIGORYANTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1808 VERDUGO BLVD SUITE 208
GLENDALE CA
91208-1477
US

IV. Provider business mailing address

412 N ISABEL ST APT D
GLENDALE CA
91206-3333
US

V. Phone/Fax

Practice location:
  • Phone: 818-952-7070
  • Fax: 818-952-7993
Mailing address:
  • Phone: 800-540-0508
  • Fax: 818-952-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA93719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: