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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