Provider Demographics
NPI:1164620100
Name:GRUNWALD, TIFFANY BETH (MD, MSED)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:BETH
Last Name:GRUNWALD
Suffix:
Gender:F
Credentials:MD, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2050
Mailing Address - Country:US
Mailing Address - Phone:310-828-4646
Mailing Address - Fax:310-828-3939
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:SUITE 430
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-828-4646
Practice Address - Fax:310-828-3939
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA755092086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery