Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 95005220 | CA |
NPI | 1013459981 |
---|---|
Provider Name | Scarlett Vanessa Grandy |
First Address | Los Angeles, CA 90015-3075 |
Second Address | Los Angeles, CA 90015-3075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2016 |
Last Update Date | 30/07/2019 |