Provider Demographics
NPI:1528184033
Name:GRITTON, LIVA YATES (MD)
Entity Type:Individual
Prefix:MRS
First Name:LIVA
Middle Name:YATES
Last Name:GRITTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80998
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91118-8998
Mailing Address - Country:US
Mailing Address - Phone:626-304-9060
Mailing Address - Fax:626-304-9010
Practice Address - Street 1:289 W HUNTINGTON DR STE 201
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3490
Practice Address - Country:US
Practice Address - Phone:626-304-9060
Practice Address - Fax:626-304-9010
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76396208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
F95695Medicare UPIN
CAG76396AMedicare ID - Type Unspecified