Provider Demographics
NPI:1265479612
Name:UBA, GRANT WESLEY (MD)
Entity Type:Individual
Prefix:MR
First Name:GRANT
Middle Name:WESLEY
Last Name:UBA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6226 E SPRING ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1423
Mailing Address - Country:US
Mailing Address - Phone:562-496-4331
Mailing Address - Fax:562-627-5620
Practice Address - Street 1:6226 E SPRING ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1423
Practice Address - Country:US
Practice Address - Phone:562-496-4331
Practice Address - Fax:562-627-5620
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-02-18
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Provider Licenses
StateLicense IDTaxonomies
CAG63861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE47650Medicare UPIN