Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A75506 | CA |
N | 207XS0117X | Orthopaedic Spine Surgeon | A75506 | CA |
NPI | 1255379939 |
---|---|
Provider Name | Dr. Tooraj Todd Gravori |
First Address | Encino, CA 91436-4349 |
Second Address | Encino, CA 91436-4349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 17/10/2019 |