Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VE0102X | Reproductive Endocrinologist | 35066572G | OH |
Y | 207VE0102X | Reproductive Endocrinologist | G87868 | CA |
NPI | 1235128315 |
---|---|
Provider Name | Clemens Martin Grosskinsky |
First Address | Danville, CA 94526-1544 |
Second Address | Walnut Creek, CA 94598-2419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0264235 | (05) | OH |