Provider Demographics
NPI:1063571834
Name:GRANT, ADRIENNE ANN (DO)
Entity type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:ANN
Last Name:GRANT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1777 N BELLFLOWER BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4019
Mailing Address - Country:US
Mailing Address - Phone:562-597-6020
Mailing Address - Fax:562-597-6024
Practice Address - Street 1:1777 N BELLFLOWER BLVD STE 107
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4019
Practice Address - Country:US
Practice Address - Phone:562-597-6020
Practice Address - Fax:562-597-6024
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7285208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice