Individual
DR. ELLSWORTH RAYMOND GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
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
G73084
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G730841
—
CA
05
—
00G730842
—
CA
01
—
954893061
TAX ID NO.
CA
Enumeration date
07/25/2006
Last updated
03/07/2023
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