Provider Demographics
NPI:1437338910
Name:GRIGORIAN, RAFIAEL
Entity Type:Individual
Prefix:MR
First Name:RAFIAEL
Middle Name:
Last Name:GRIGORIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6033 ATLANTIC BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90270-3193
Mailing Address - Country:US
Mailing Address - Phone:323-562-8800
Mailing Address - Fax:323-562-8811
Practice Address - Street 1:6033 ATLANTIC BLVD STE 8
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-3193
Practice Address - Country:US
Practice Address - Phone:323-562-8800
Practice Address - Fax:323-562-8811
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132948332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5387670001Medicare NSC