Organization
GRANT STEVENS, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA PALOMARES (INSURANCE COORDINATOR)
(310) 827-2653
Entity
Organization
Contact information
Practice address
4644 LINCOLN BLVD, SUITE 552, MARINA DEL REY, CA 90292-6391
(310) 827-2653
(310) 823-1984
Mailing address
4644 LINCOLN BLVD, SUITE 552, MARINA DEL REY, CA 90292-6391
(310) 827-2653
(310) 823-1984
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
A116508
CA
208200000X
Plastic Surgery Physician
A94136
CA
208200000X
Plastic Surgery Physician
G45892
CA
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
03/21/2012
Last updated
05/05/2014
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