Healthcare Provider Details

I. General information

NPI: 1902089006
Provider Name (Legal Business Name): STEPHEN P GRIFKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 LOMITA BLVD STE 321
TORRANCE CA
90505-1927
US

IV. Provider business mailing address

703 PIER AVE STE 145
HERMOSA BEACH CA
90254-3949
US

V. Phone/Fax

Practice location:
  • Phone: 310-775-7795
  • Fax: 310-818-5551
Mailing address:
  • Phone: 310-625-5657
  • Fax: 310-818-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberG48648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: