Provider Demographics
NPI:1972708840
Name:GRIGORIAN, VREJ
Entity Type:Individual
Prefix:DR
First Name:VREJ
Middle Name:
Last Name:GRIGORIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CALLE PECOS
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2347
Mailing Address - Country:US
Mailing Address - Phone:805-498-2766
Mailing Address - Fax:
Practice Address - Street 1:1202 CALLE PECOS
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-2347
Practice Address - Country:US
Practice Address - Phone:805-498-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE12126174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist