MEDICARE: BRIDGET DENICE GRISBY

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	373H00000X	Day Training/Habilitation Specialist		CA

General Provider Information

NPI Number	:	1487528139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET DENICE GRISBY

Provider Business Mailing Address
First Line	:	9450 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3859
Country	:	US
Telephone Number	:	323-358-4018
Fax Number	:

Provider Business Practice Location Address
First Line	:	9450 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-3859
Country	:	US
Telephone Number	:	323-358-4018
Fax Number	:

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

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	01/12/2026

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Directions to “ BRIDGET DENICE GRISBY ” Practice Location

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