Healthcare Provider Details

I. General information

NPI: 1700697604
Provider Name (Legal Business Name): MOLLY YORKE GRIGORIAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 S SIERRA MADRE BLVD
PASADENA CA
91107-5240
US

IV. Provider business mailing address

2547 ALTURA AVE
MONTROSE CA
91020-1103
US

V. Phone/Fax

Practice location:
  • Phone: 323-203-1223
  • Fax:
Mailing address:
  • Phone: 323-203-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029869
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: