Healthcare Provider Details

I. General information

NPI: 1962204792
Provider Name (Legal Business Name): JOSEPH ANTHONY GRECH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 CHARLES E YOUNG DR S
LOS ANGELES CA
90095-8342
US

IV. Provider business mailing address

10660 JERICHO DR
ROSCOMMON MI
48653-8435
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-7375
  • Fax:
Mailing address:
  • Phone: 989-915-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: