Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A96813 | CA |
NPI | 1164580866 |
---|---|
Provider Name | Dr. Mark I Grijnsztein |
First Address | Sacramento, CA 95827-2539 |
Second Address | Elk Grove, CA 95758-7901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 29/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I19906 | (02) | CA |