Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A75509 | CA |
NPI | 1164620100 |
---|---|
Provider Name | Tiffany Beth Grunwald |
First Address | Santa Monica, CA 90404-2050 |
Second Address | Santa Monica, CA 90404-2050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 13/01/2014 |