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General NPI Number Information
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NPI Number | 1306062930
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Entity Type | Organization
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Legal Business Name | GRANT MEDICAL CLINIC
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 274 S ATLANTIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90022-1733
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Country | US
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Telephone | 323-267-0442
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 227037
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City | LOS ANGELES
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State | CA
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Zip | 90022-0737
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Country | US
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Telephone | 323-267-0442
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RONALD A GRANT
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Credential |
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Telephone | 323-267-0442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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