Individual
GREGG SMALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15720 VENTURA BLVD, #227, ENCINO, CA 91436-2914
(310) 385-5807
Mailing address
15720 VENTURA BLVD, #227, ENCINO, CA 91436-2914
(310) 385-5807
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
G70119
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598855306
NPI 1598855306
—
01
—
G70119
LICENSE
CA
Enumeration date
10/13/2006
Last updated
06/20/2012
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