Provider Demographics
NPI:1073632402
Name:LIVA YATES GRITTON, M.D., INC.
Entity Type:Organization
Organization Name:LIVA YATES GRITTON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIVA
Authorized Official - Middle Name:YATES
Authorized Official - Last Name:GRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-304-9060
Mailing Address - Street 1:P.O. BOX 80998
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91118-8998
Mailing Address - Country:US
Mailing Address - Phone:626-304-9060
Mailing Address - Fax:626-304-9010
Practice Address - Street 1:960 E GREEN ST STE 254
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2418
Practice Address - Country:US
Practice Address - Phone:626-304-9060
Practice Address - Fax:626-304-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76396208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG76396AMedicare ID - Type Unspecified
CAF95695Medicare UPIN