Healthcare Provider Details

I. General information

NPI: 1124682745
Provider Name (Legal Business Name): GRIFFIN MICHAEL ELBERT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MARICOPA HWY STE D
OJAI CA
93023-3154
US

IV. Provider business mailing address

1320 MARICOPA HWY STE D
OJAI CA
93023-3154
US

V. Phone/Fax

Practice location:
  • Phone: 805-948-6730
  • Fax: 805-948-6731
Mailing address:
  • Phone: 805-948-6730
  • Fax: 805-948-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A19673
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A19673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: