Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A98644 | CA |
NPI | 1013109321 |
---|---|
Provider Name | Phillip Gruber |
First Address | Pasadena, CA 91115-0693 |
Second Address | Los Angeles, CA 90033-1029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 10/08/2007 |