MEDICARE: GALINA GREKOV NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	95017333	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95017333	OTHER	CA	NP LICENSE NUMBER

General Provider Information

NPI Number	:	1114693520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALINA GREKOV NP

Provider Business Mailing Address
First Line	:	248 E HOWARD ST
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2123
Country	:	US
Telephone Number	:	818-404-2910
Fax Number	:

Provider Business Practice Location Address
First Line	:	8713 BEVERLY BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1803
Country	:	US
Telephone Number	:	347-693-2287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	10/14/2022

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