Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 19169 | CA |
Y | 103TC0700X | Clinical Psychologist | 19169 | CA |
NPI | 1013100635 |
---|---|
Provider Name | Dr. Sharon M. Gruber |
First Address | Mission Viejo, CA 92691-6360 |
Second Address | Mission Viejo, CA 92691-6360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2007 |
Last Update Date | 22/02/2013 |