Provider Demographics
NPI:1902089006
Name:GRIFKA, STEPHEN P (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:GRIFKA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:703 PIER AVE
Mailing Address - Street 2:STE 145
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3949
Mailing Address - Country:US
Mailing Address - Phone:310-625-5657
Mailing Address - Fax:310-818-5551
Practice Address - Street 1:3655 LOMITA BLVD
Practice Address - Street 2:STE 321
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-1927
Practice Address - Country:US
Practice Address - Phone:310-775-7795
Practice Address - Fax:310-818-5551
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2016-12-22
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Provider Licenses
StateLicense IDTaxonomies
CAG48648207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG48648Medicare UPIN