Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G72924 | CA |
NPI | 1003955303 |
---|---|
Provider Name | Dr. Paula Grayson |
First Address | Los Angeles, CA 90074-0001 |
Second Address | San Diego, CA 92130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 25/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G729240 | (05) | CA |
013 | CHAMPUS (01) | |
370019759 | RAILROAD MEDICARE (01) |