Individual
MRS. ELIZABETH ANN GRIVETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
360 SAN MIGUEL DR, SUITE 501, NEWPORT BEACH, CA 92660-7853
(949) 644-1025
(949) 719-4930
Mailing address
360 SAN MIGUEL DR, SUITE 501, NEWPORT BEACH, CA 92660-7853
(949) 644-1025
(949) 719-4930
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA13761
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WPA13761C
PERFORMING PHYSICIAN ID#
CA
Enumeration date
06/13/2006
Last updated
07/08/2007
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