Provider Demographics
NPI:1770601429
Name:RAYMOND D. GRITTON, M.D., INC.
Entity type:Organization
Organization Name:RAYMOND D. GRITTON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIVA
Authorized Official - Middle Name:YATES
Authorized Official - Last Name:GRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-304-9060
Mailing Address - Street 1:PO BOX 80998
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91118-8998
Mailing Address - Country:US
Mailing Address - Phone:626-304-9060
Mailing Address - Fax:626-304-9010
Practice Address - Street 1:289 W HUNTINGTON DR STE 201
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3490
Practice Address - Country:US
Practice Address - Phone:626-304-9060
Practice Address - Fax:626-304-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76722208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG08068Medicare UPIN
CAG76722AMedicare ID - Type Unspecified