Provider Demographics
NPI:1104196203
Name:GRUBIC, VESNA (RN, MSN, ANP, MPH)
Entity Type:Individual
Prefix:
First Name:VESNA
Middle Name:
Last Name:GRUBIC
Suffix:
Gender:F
Credentials:RN, MSN, ANP, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N CLARK DR # 33
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1744
Mailing Address - Country:US
Mailing Address - Phone:310-657-4276
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 590W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6163
Practice Address - Country:US
Practice Address - Phone:310-423-2641
Practice Address - Fax:310-423-0588
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21169363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health