Provider Demographics
NPI:1659602720
Name:GRIGORIAN, ALEX S (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:S
Last Name:GRIGORIAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1045 ATLANTIC AVE
Mailing Address - Street 2:SUITE 611
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3408
Mailing Address - Country:US
Mailing Address - Phone:562-491-9823
Mailing Address - Fax:562-432-0111
Practice Address - Street 1:1045 ATLANTIC AVE
Practice Address - Street 2:SUITE 611
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3408
Practice Address - Country:US
Practice Address - Phone:562-491-9823
Practice Address - Fax:562-432-0111
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 20518363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical