Provider Demographics
NPI:1407916885
Name:GRANDBOIS, PAULA MARIE (RNFA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:GRANDBOIS
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W IMPERIAL AVE
Mailing Address - Street 2:#42
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2053
Mailing Address - Country:US
Mailing Address - Phone:310-251-4532
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD
Practice Address - Street 2:#603
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4165
Practice Address - Country:US
Practice Address - Phone:310-423-9211
Practice Address - Fax:310-423-9958
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446945163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant