Organization
WESTSIDE NEPHROLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MORRIS GRABIE MD (OWNER PRESIDENT)
(310) 829-3639
Entity
Organization
Contact information
Practice address
1301 20TH ST STE 200, SANTA MONICA, CA 90404-2088
(310) 829-3639
Mailing address
1301 20TH ST STE 200, SANTA MONICA, CA 90404-2088
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G34196
CA
207RN0300X
Nephrology Physician
Primary
G34196
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0063610
—
CA
05
—
ZZZ24192Z
—
CA
Enumeration date
05/09/2007
Last updated
09/10/2014
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