Organization
GRANT MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD A GRANT (OWNER)
(323) 267-0442
Entity
Organization
Contact information
Practice address
274 S ATLANTIC BLVD, LOS ANGELES, CA 90022-1733
(323) 267-0442
Mailing address
PO BOX 227037, LOS ANGELES, CA 90022-0737
(323) 267-0442
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0065180
—
CA
Enumeration date
04/18/2007
Last updated
11/03/2011
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