Healthcare Provider Details

I. General information

NPI: 1306741590
Provider Name (Legal Business Name): JUDD NORMAN GRILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 S BRONSON AVE
LOS ANGELES CA
90020-4720
US

IV. Provider business mailing address

560 S BRONSON AVE
LOS ANGELES CA
90020-4720
US

V. Phone/Fax

Practice location:
  • Phone: 917-916-9488
  • Fax:
Mailing address:
  • Phone: 917-916-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: