Provider Demographics
NPI:1588005359
Name:GRIMMIG, ANGELA MARIA (PSYD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:GRIMMIG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38139 BALCH PARK RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93265-9762
Mailing Address - Country:US
Mailing Address - Phone:310-936-3621
Mailing Address - Fax:
Practice Address - Street 1:38139 BALCH PARK RD
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:CA
Practice Address - Zip Code:93265-9762
Practice Address - Country:US
Practice Address - Phone:310-936-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23186103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist