Provider Demographics
NPI:1235321621
Name:GRIFFIN, STEVEN RAY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RAY
Last Name:GRIFFIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27555 YNEZ RD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4687
Mailing Address - Country:US
Mailing Address - Phone:951-699-3299
Mailing Address - Fax:951-699-5679
Practice Address - Street 1:27555 YNEZ RD
Practice Address - Street 2:SUITE 370
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4687
Practice Address - Country:US
Practice Address - Phone:951-699-3299
Practice Address - Fax:951-699-5679
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.200931208000000X
CAA102423208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1237876Medicaid