Provider Demographics
NPI:1144581356
Name:ALEKSANDR GRINBERG MD, INC
Entity Type:Organization
Organization Name:ALEKSANDR GRINBERG MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-286-6530
Mailing Address - Street 1:2320 SUTTER ST
Mailing Address - Street 2:OFFICE 101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3038
Mailing Address - Country:US
Mailing Address - Phone:415-771-0700
Mailing Address - Fax:415-928-1311
Practice Address - Street 1:2320 SUTTER ST
Practice Address - Street 2:OFFICE 101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3038
Practice Address - Country:US
Practice Address - Phone:415-771-0700
Practice Address - Fax:415-928-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56467261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9996133Medicaid
CA9996133Medicaid
CA00A5646710Medicare PIN