Doctor Name: | DR. MARAT GRIGOROV |
NPI Number: | 1063613628 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 20A9361 |
Business Practice Address: | Naval Hospital Military Sick Clinic Marine Corp Air Ground Combat Center Twentynine Palms, CA - 92278 |
Business Phone Number: | 7608305220 |
Business Fax Number: | |
Mailing Address: | 57226 Jarana Ct, YUCCA VALLEY |
State: | CA |
Postal Code: | 922844175 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/30/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 20A9361 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |