| Grancell Village Clinic | |
|
7150 Tampa Ave Reseda CA 91335 | |
| (818) 774-3000 | |
| Not Available |
| Full Name | Grancell Village Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 7150 Tampa Ave, Reseda, California |
| Authorized Official Name and Position | Mary M Forrest (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8187743208 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grancell Village Clinic 7150 Tampa Ave Reseda CA 91335-3700 Ph: (818) 774-3000 | Grancell Village Clinic 7150 Tampa Ave Reseda CA 91335 Ph: (818) 774-3000 |
| NPI Number | 1811990377 |
|---|---|
| Provider Enumeration Date | 05/27/2005 |
| Last Update Date | 07/02/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811990377 | NPI | - | NPPES |
| CMM70542F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 960000819 (California) | Primary |
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