Provider Demographics
NPI:1396146486
Name:GRINBERG, SVETLANA (DO)
Entity type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:GRINBERG
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:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-0278
Mailing Address - Country:US
Mailing Address - Phone:423-442-2622
Mailing Address - Fax:423-442-5760
Practice Address - Street 1:704 LEBEC ROAD
Practice Address - Street 2:
Practice Address - City:LEBEC
Practice Address - State:CA
Practice Address - Zip Code:93243
Practice Address - Country:US
Practice Address - Phone:661-248-5250
Practice Address - Fax:661-248-5279
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine