Healthcare Provider Details

I. General information

NPI: 1437338910
Provider Name (Legal Business Name): MR. RAFIAEL GRIGORIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6033 ATLANTIC BLVD STE 8
MAYWOOD CA
90270-3193
US

IV. Provider business mailing address

6033 ATLANTIC BLVD STE 8
MAYWOOD CA
90270-3193
US

V. Phone/Fax

Practice location:
  • Phone: 323-562-8800
  • Fax: 323-562-8811
Mailing address:
  • Phone: 323-562-8800
  • Fax: 323-562-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number132948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: