Provider Demographics
NPI:1225104649
Name:GRIFFIN, MOLLY E (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:E
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1260 15TH ST
Mailing Address - Street 2:SUITE 1112
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1135
Mailing Address - Country:US
Mailing Address - Phone:310-255-0221
Mailing Address - Fax:310-255-0209
Practice Address - Street 1:1260 15TH ST STE 1112
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1146
Practice Address - Country:US
Practice Address - Phone:310-255-0221
Practice Address - Fax:310-255-0209
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA055479207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology