Healthcare Provider Details

I. General information

NPI: 1740005479
Provider Name (Legal Business Name): LEV GRINMAN MD 4 PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23929 VALENCIA BLVD STE 309
VALENCIA CA
91355-5379
US

IV. Provider business mailing address

23929 VALENCIA BLVD STE 309
VALENCIA CA
91355-5379
US

V. Phone/Fax

Practice location:
  • Phone: 818-392-0990
  • Fax:
Mailing address:
  • Phone: 818-392-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TYLER STOUT
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 337-315-7927