Healthcare Provider Details

I. General information

NPI: 1326473067
Provider Name (Legal Business Name): CRISTIN GRANT FERRARA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTIN DORRIS GRANT

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-1037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number23501
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number23501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: