Provider Demographics
NPI:1932175460
Name:TODD M GREHL MD INC
Entity Type:Organization
Organization Name:TODD M GREHL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-726-2500
Mailing Address - Street 1:PO BOX 1970
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067
Mailing Address - Country:US
Mailing Address - Phone:760-726-2500
Mailing Address - Fax:760-726-3279
Practice Address - Street 1:3998 VISTA WAY
Practice Address - Street 2:#C204
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056
Practice Address - Country:US
Practice Address - Phone:760-726-2500
Practice Address - Fax:760-726-3279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16965208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G169650Medicaid
G16965Medicare ID - Type Unspecified
CA00G169650Medicaid