Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | G76722 | CA |
NPI | 1003934043 |
---|---|
Provider Name | Mr. Raymond D Gritton |
First Address | San Marino, CA 91118-8998 |
Second Address | Pasadena, CA 91106-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 04/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G08068 | (02) |