Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 10779 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 10779 | CA |
NPI | 1013003813 |
---|---|
Provider Name | Dr. Kenneth Patrick Grebel |
First Address | Santa Ana, CA 92701-4519 |
Second Address | Santa Ana, CA 92701-4519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |