Provider Demographics
NPI:1437985728
Name:MOLLY, GRIFFIN (LAC)
Entity type:Individual
Prefix:MR
First Name:GRIFFIN
Middle Name:
Last Name:MOLLY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S GRAND AVE APT 1015
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-2172
Mailing Address - Country:US
Mailing Address - Phone:646-645-0704
Mailing Address - Fax:
Practice Address - Street 1:1111 S GRAND AVE APT 1015
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2172
Practice Address - Country:US
Practice Address - Phone:646-645-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19430171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist