Provider Demographics
NPI:1497946594
Name:TIFFANY B GRUNWALD, MD, INC.
Entity Type:Organization
Organization Name:TIFFANY B GRUNWALD, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRUNWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-828-4646
Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2050
Mailing Address - Country:US
Mailing Address - Phone:310-828-4646
Mailing Address - Fax:310-828-3939
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:SUITE 430
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-828-4646
Practice Address - Fax:310-828-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty