Provider Demographics
NPI:1164580866
Name:GRIJNSZTEIN, MARK I (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:I
Last Name:GRIJNSZTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:8170 LAGUNA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7901
Practice Address - Country:US
Practice Address - Phone:916-478-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96813207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI19906Medicare UPIN
CAAU059ZMedicare PIN