Healthcare Provider Details

I. General information

NPI: 1861482143
Provider Name (Legal Business Name): CATHERINE D GRITCHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 N BELLFLOWER BLVD
LONG BEACH CA
90815-3126
US

IV. Provider business mailing address

17360 BROOKHURST STREET ATTN: MCMF - CREDENTIALING DEPT.
FOUNTAIN VALLEY CA
92708-3720
US

V. Phone/Fax

Practice location:
  • Phone: 562-346-2222
  • Fax:
Mailing address:
  • Phone: 657-241-3592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA79436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: