Provider Demographics
NPI:1053418939
Name:GRELLET, CATHERINE ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ANNE
Last Name:GRELLET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15251 NATIONAL AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2400
Mailing Address - Country:US
Mailing Address - Phone:408-358-7360
Mailing Address - Fax:408-358-7357
Practice Address - Street 1:15251 NATIONAL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2400
Practice Address - Country:US
Practice Address - Phone:408-358-7360
Practice Address - Fax:408-358-7357
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55508207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0187703OtherEIN
CAA52965Medicare UPIN