Provider Demographics
NPI:1184514507
Name:GRYZELKO, YASMIN
Entity type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:GRYZELKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11628 205TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-1303
Mailing Address - Country:US
Mailing Address - Phone:310-882-1280
Mailing Address - Fax:
Practice Address - Street 1:500 E CARSON PLAZA DR
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3225
Practice Address - Country:US
Practice Address - Phone:213-793-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program