Healthcare Provider Details

I. General information

NPI: 1841660297
Provider Name (Legal Business Name): KARLA GRIMM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 ATLANTIC AVE
LONG BEACH CA
90806-2755
US

IV. Provider business mailing address

2760 ATLANTIC AVE
LONG BEACH CA
90806-2755
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-3441
  • Fax: 562-424-0086
Mailing address:
  • Phone: 562-424-3441
  • Fax: 562-424-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number339235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: