Provider Demographics
NPI:1801152665
Name:CENTER FOR FALL PREVENTION, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:CENTER FOR FALL PREVENTION, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GRIFKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-395-2636
Mailing Address - Street 1:212 26TH ST # 160
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2524
Mailing Address - Country:US
Mailing Address - Phone:888-419-2775
Mailing Address - Fax:866-864-4566
Practice Address - Street 1:3831 HUGHES AVE STE 608
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6851
Practice Address - Country:US
Practice Address - Phone:888-419-2775
Practice Address - Fax:866-864-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48648207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFC580ZMedicare UPIN