MEDICARE: EZKIEL GRIFFIN

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	1041C0700X	Clinical Social Worker	112581	CA

General Provider Information

NPI Number	:	1407219116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EZKIEL GRIFFIN

Provider Business Mailing Address
First Line	:	1027 WILSHIRE BLVD APT 705
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3126
Country	:	US
Telephone Number	:	347-526-5354
Fax Number	:

Provider Business Practice Location Address
First Line	:	1027 WILSHIRE BLVD APT 705
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3126
Country	:	US
Telephone Number	:	347-526-5354
Fax Number	:

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

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	10/30/2024

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