Basic Information
| Provider Information | |||||||||
| NPI: | 1790849503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIGORYANTS | ||||||||
| FirstName: | VLADIMIR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 412 N ISABEL ST APT D | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912063333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005400508 | ||||||||
| FaxNumber: | 8189527993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1808 VERDUGO BLVD | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912081477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189527070 | ||||||||
| FaxNumber: | 8189527993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | A93719 | CA | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.