Provider Demographics
NPI:1295474260
Name:GRANDVIEW MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:GRANDVIEW MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARITESS
Authorized Official - Middle Name:
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-967-3176
Mailing Address - Street 1:1114 HIGHLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-3492
Mailing Address - Country:US
Mailing Address - Phone:626-422-0121
Mailing Address - Fax:
Practice Address - Street 1:315 N 3RD AVE STE 200
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1915
Practice Address - Country:US
Practice Address - Phone:626-967-3176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRANDVIEW MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-30
Last Update Date:2022-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty