Provider Demographics
NPI:1225466451
Name:GRIGORYAN, GRATCH (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:GRATCH
Middle Name:
Last Name:GRIGORYAN
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 W COLORADO ST STE 303
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-3641
Mailing Address - Country:US
Mailing Address - Phone:818-545-7222
Mailing Address - Fax:
Practice Address - Street 1:541 W COLORADO ST STE 303
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-3641
Practice Address - Country:US
Practice Address - Phone:818-545-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7485171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist