MEDICARE: BIANCA GRIGORIAN MD

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	207R00000X	Internal Medicine Physician	A85318	CA

General Provider Information

NPI Number	:	1427053693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA GRIGORIAN MD

Provider Business Mailing Address
First Line	:	133 N ALTADENA DR
Second Line	:	2ND FLOOR
City	:	PASADENA
State	:	CA
Zip	:	91107-7325
Country	:	US
Telephone Number	:	626-397-8335
Fax Number	:	626-397-8337

Provider Business Practice Location Address
First Line	:	65 N MADISON AVE
Second Line	:	STE 800
City	:	PASADENA
State	:	CA
Zip	:	91101-2038
Country	:	US
Telephone Number	:	626-792-3141
Fax Number	:	626-792-9193

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	01/16/2014

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