Healthcare Provider Details

I. General information

NPI: 1528156619
Provider Name (Legal Business Name): JOSEPH LEONARD GRZESKIEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE SUITE 480
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

17041 COYOTE CT
POWAY CA
92064-1133
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-2066
  • Fax: 858-452-1875
Mailing address:
  • Phone: 858-451-1278
  • Fax: 858-385-0389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG66889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: