Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 124666 | CA |
NPI | 1013483197 |
---|---|
Provider Name | Brooke Anne Grisolia |
First Address | Los Angeles, CA 90013-1772 |
Second Address | Los Angeles, CA 90034-1702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2018 |
Last Update Date | 17/12/2021 |