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Organization
ELLSWORTH GRANT, M.D., MEDICAL CORP
Active
Organization
ELLSWORTH GRANT, M.D., MEDICAL CORP
Active
Other names
Ellsworth R. Grant, M.D.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELIZABETH C VENTURA HCI (OFFICE MANAGER)
(213) 481-3948
Entity
Organization
Contact information
Practice address
1245 WILSHIRE BLVD, SUITE 801, LOS ANGELES, CA 90017-4810
(213) 481-3948
(213) 481-1697
Mailing address
1245 WILSHIRE BLVD, SUITE 801, LOS ANGELES, CA 90017-4810
(213) 481-3948
(213) 481-1697
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
G073084
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G730841
—
CA
05
—
00G730842
—
CA
01
—
AY691
MEDICARE PTAN
CA
01
—
G073084
CALIFORNIA STATE LICENSE
CA
Enumeration date
11/01/2006
Last updated
06/21/2018
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