Healthcare Provider Details

I. General information

NPI: 1588005359
Provider Name (Legal Business Name): ANGELA MARIA GRIMMIG PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38139 BALCH PARK RD
SPRINGVILLE CA
93265-9762
US

IV. Provider business mailing address

38139 BALCH PARK RD
SPRINGVILLE CA
93265-9762
US

V. Phone/Fax

Practice location:
  • Phone: 310-936-3621
  • Fax:
Mailing address:
  • Phone: 310-936-3621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: