Organization
PAUL J GRODAN M.D. A PROFESSIONAL CORPORATION
Active
Organization
PAUL J GRODAN M.D. A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL JOHN GRODAN M.D. (PRESIDENT)
(310) 854-0100
Entity
Organization
Contact information
Practice address
150 N ROBERTSON BLVD, SUITE 211, BEVERLY HILLS, CA 90211-2142
(310) 854-0100
(310) 659-3297
Mailing address
150 N ROBERTSON BLVD, SUITE 211, BEVERLY HILLS, CA 90211-2142
(310) 854-0100
(310) 659-3297
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
G30279
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G302790
—
CA
01
—
G30279
MEDICARE ID-TYPE UNSPECIFIED
CA
Enumeration date
03/02/2010
Last updated
03/02/2010
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