Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 25MD00298800 | NJ |
N | 222Z00000X | Podiatrist | 25MD00298800 | NJ |
N | 213E00000X | Podiatrist | N005980 | NY |
N | 222Z00000X | Podiatrist | N005980 | NY |
Y | 213EP1101X | Primary Podiatric Medicine | E4987 | CA |
NPI | 1609817535 |
---|---|
Provider Name | Dr. Grigoriy N Patish |
First Address | Fallbrook, CA 92028-3086 |
Second Address | Fallbrook, CA 92028-3086 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2006 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02639412 | (05) | NY |
U98353 | (02) |