Provider Demographics
NPI:1497765986
Name:GRINSTED, STEVEN ALBERT (PT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ALBERT
Last Name:GRINSTED
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2442
Mailing Address - Country:US
Mailing Address - Phone:213-617-2947
Mailing Address - Fax:213-617-2903
Practice Address - Street 1:708 W 1ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2442
Practice Address - Country:US
Practice Address - Phone:213-617-2947
Practice Address - Fax:213-617-2903
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24988174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66237ZOtherBLUE SHIELD
CAQ12777Medicare UPIN
CAWPT24988BMedicare ID - Type Unspecified