Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | G63051 | CA |
NPI | 1073543914 |
---|---|
Provider Name | Dr. Michael Lee Griffin |
First Address | Menlo Park, CA 94025-6601 |
Second Address | San Mateo, CA 94403-1719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G630510 | MEDICAL (01) | CA |
A 537 19 | (02) | CA |