Healthcare Provider Details

I. General information

NPI: 1043604754
Provider Name (Legal Business Name): ADRIENNE GRZENDA M.D., PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14659 OLIVE VIEW DR
SYLMAR CA
91342-1652
US

IV. Provider business mailing address

14659 OLIVE VIEW DR
SYLMAR CA
91342-1652
US

V. Phone/Fax

Practice location:
  • Phone: 818-485-0888
  • Fax:
Mailing address:
  • Phone: 818-485-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA146893
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: