Provider Demographics
NPI:1992973010
Name:GRIFFIN, GAYE (RN, MA)
Entity type:Individual
Prefix:MS
First Name:GAYE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RN, MA
Other - Prefix:MS
Other - First Name:GAYE
Other - Middle Name:L
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, MA
Mailing Address - Street 1:5602 VALLEY GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2122
Mailing Address - Country:US
Mailing Address - Phone:310-340-4400
Mailing Address - Fax:
Practice Address - Street 1:5602 VALLEY GLEN WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2122
Practice Address - Country:US
Practice Address - Phone:310-340-4400
Practice Address - Fax:310-300-1818
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN508933163W00000X, 163WC1500X, 163WG0600X, 163WH0200X, 163WH1000X, 171M00000X, 313M00000X
CA7104163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992973010Medicaid
CA1992973010Medicare NSC
CA1992973010Medicare UPIN