Provider Demographics
NPI:1588637193
Name:GRENIER, RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GRENIER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8078 E. SANTA ANA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92835
Mailing Address - Country:US
Mailing Address - Phone:714-974-2900
Mailing Address - Fax:714-279-7501
Practice Address - Street 1:8078 E. SANTA ANA CANYON RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM HILLS
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-974-2900
Practice Address - Fax:714-279-7501
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2097213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5568080001OtherDME
1588637193OtherNPI
1124264833OtherNPI GROUP
CAE2097OtherSTAE DPM LIC #
CA5568080001Medicare NSC
CA5568080001OtherDME