Provider Demographics
NPI:1114171865
Name:GRYZIEC, KARSTEN GROTH (LAC, CMT)
Entity Type:Individual
Prefix:MR
First Name:KARSTEN
Middle Name:GROTH
Last Name:GRYZIEC
Suffix:
Gender:M
Credentials:LAC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1147
Mailing Address - Country:US
Mailing Address - Phone:415-601-2532
Mailing Address - Fax:
Practice Address - Street 1:1317 18TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-2822
Practice Address - Country:US
Practice Address - Phone:415-601-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist