Healthcare Provider Details

I. General information

NPI: 1669791588
Provider Name (Legal Business Name): JOULETA GRIGORIAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2462 W WHITTIER BLVD
MONTEBELLO CA
90640-3041
US

IV. Provider business mailing address

2462 W WHITTIER BLVD
MONTEBELLO CA
90640-3041
US

V. Phone/Fax

Practice location:
  • Phone: 323-721-6222
  • Fax: 323-722-7734
Mailing address:
  • Phone: 323-721-6222
  • Fax: 323-722-7734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC23519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: