Healthcare Provider Details

I. General information

NPI: 1699974204
Provider Name (Legal Business Name): INESSA GRINBERG M.D. PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 SAN VICENTE BLVD STE 5O0
LOS ANGELES CA
90048-5425
US

IV. Provider business mailing address

6330 SAN VICENTE BLVD STE 5O0
LOS ANGELES CA
90048-5425
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-0770
  • Fax: 310-854-0440
Mailing address:
  • Phone: 310-854-0770
  • Fax: 310-854-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA108336
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: