Granoff, Mark Elliott
Granoff, Mark Elliott is an sole proprietor health care provider with primary practice located at 8635 W 3Rd St Suite 790W, Los Angeles CA 90048-6101. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Granoff, Mark Elliott can be contacted via phone (310) 855-8081.Contact Information
Primary practice address
8635 W 3Rd St Suite 790W
Los Angeles CA 90048-6101
Phone: (310) 855-8081
Fax: (310) 855-0438
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | G30036 | California |
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | G30036 | California |
Profile Details
| NPI number | 1124058474 |
|---|---|
| LBN Legal business name | Granoff, Mark Elliott |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 3rd, 2006 |
| Last updated | Jun 20th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124058474 | NPPES |
| California | Other | 00G300360 | BLUE SHIELD |
| California | Other | 110021538 | BLUE SHIELD |
| California | Other | 4042708 | BLUE SHIELD |
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