Provider Demographics
NPI:1699974204
Name:GRINBERG, INESSA (MD PHD)
Entity type:Individual
Prefix:DR
First Name:INESSA
Middle Name:
Last Name:GRINBERG
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8530 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3122
Mailing Address - Country:US
Mailing Address - Phone:310-854-0770
Mailing Address - Fax:310-854-0440
Practice Address - Street 1:8530 WILSHIRE BLVD
Practice Address - Street 2:SUITE 520
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3122
Practice Address - Country:US
Practice Address - Phone:310-854-0770
Practice Address - Fax:310-854-0440
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics