Healthcare Provider Details

I. General information

NPI: 1104196203
Provider Name (Legal Business Name): VESNA GRUBIC RN, MSN, ANP, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 590W
LOS ANGELES CA
90048-6163
US

IV. Provider business mailing address

168 N CLARK DR # 33
BEVERLY HILLS CA
90211-1744
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-2641
  • Fax: 310-423-0588
Mailing address:
  • Phone: 310-657-4276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number21169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: