Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | G13885 | CA |
NPI | 1023101557 |
---|---|
Provider Name | Carl Mayer Grushkin |
First Address | Los Angeles, CA 90028-7900 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G138850 | (05) | CA |
00G138850G07 | CALOPTIMA (01) | CA |
A39110 | (02) | CA |