Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 20978 | CA |
NPI | 1134471360 |
---|---|
Provider Name | Cary G Gross |
First Address | Los Angeles, CA 90064-4416 |
Second Address | Sylmar, CA 91342-1438 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2012 |
Last Update Date | 18/05/2020 |