Provider Demographics
NPI:1669491486
Name:GREWAL, AJITA (MD)
Entity Type:Individual
Prefix:
First Name:AJITA
Middle Name:
Last Name:GREWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:762 ALTOS OAKS DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5434
Mailing Address - Country:US
Mailing Address - Phone:650-948-9123
Mailing Address - Fax:650-948-0563
Practice Address - Street 1:762 ALTOS OAKS DR
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5434
Practice Address - Country:US
Practice Address - Phone:650-948-9123
Practice Address - Fax:650-948-0563
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA061389207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BY378AMedicare PIN
CAG97031Medicare UPIN