Healthcare Provider Details

I. General information

NPI: 1174775670
Provider Name (Legal Business Name): BRENDAN HOWARD GRUBBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 11/27/2023
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N VERMONT AVE STE 301
LOS ANGELES CA
90027-6061
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-6070
  • Fax:
Mailing address:
  • Phone: 323-361-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA99421
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA99421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: