Healthcare Provider Details

I. General information

NPI: 1679917561
Provider Name (Legal Business Name): ERWIN GRUSSIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 WILSHIRE BLVD # 2F
LOS ANGELES CA
90025-6602
US

IV. Provider business mailing address

181 S BUENA VISTA ST
BURBANK CA
91505-4504
US

V. Phone/Fax

Practice location:
  • Phone: 310-231-2121
  • Fax:
Mailing address:
  • Phone: 818-748-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA138355
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberA138355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: