Provider Demographics
NPI:1619088440
Name:TIU, GRISELDA EMPENO (MD)
Entity Type:Individual
Prefix:DR
First Name:GRISELDA
Middle Name:EMPENO
Last Name:TIU
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 1:655 EUCLID AVE
Mailing Address - Street 2:STE. 210
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2957
Mailing Address - Country:US
Mailing Address - Phone:619-475-4004
Mailing Address - Fax:619-479-2793
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:STE. 210
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-475-4004
Practice Address - Fax:619-479-2793
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A495652Medicaid
CAE50632Medicare UPIN
CAA49565BMedicare PIN