Provider Demographics
NPI:1871868968
Name:GROCK, SHIRA MIRIAM (MD)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:MIRIAM
Last Name:GROCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:
Other - Last Name:FRANKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8707
Mailing Address - Fax:
Practice Address - Street 1:2020 SANTA MONICA BLVD STE 550
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2125
Practice Address - Country:US
Practice Address - Phone:310-828-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136419207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism