Provider Demographics
NPI:1528156619
Name:GRZESKIEWICZ, JOSEPH LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEONARD
Last Name:GRZESKIEWICZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:17041 COYOTE CT
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-1133
Mailing Address - Country:US
Mailing Address - Phone:858-451-1278
Mailing Address - Fax:858-385-0389
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 480
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-452-2066
Practice Address - Fax:858-452-1875
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG66889208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF11503Medicare UPIN