Provider Demographics
NPI:1528650306
Name:GRIGORYEV, KAREN ILENA BLEKH (DPT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ILENA BLEKH
Last Name:GRIGORYEV
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20823 STEVENS CREEK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2112
Mailing Address - Country:US
Mailing Address - Phone:408-252-6076
Mailing Address - Fax:408-252-1159
Practice Address - Street 1:20823 STEVENS CREEK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2112
Practice Address - Country:US
Practice Address - Phone:408-252-6076
Practice Address - Fax:408-252-6076
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299711208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation