Healthcare Provider Details

I. General information

NPI: 1063986180
Provider Name (Legal Business Name): MARIA MICHELLE GRYWALSKI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 401
LONG BEACH CA
90806-2743
US

IV. Provider business mailing address

2116 W MILLS DR
ORANGE CA
92868-3430
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-2662
  • Fax:
Mailing address:
  • Phone: 714-390-8541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017030387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: