Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | G039997 | CA |
NPI | 1053462606 |
---|---|
Provider Name | Robert A Grossman |
First Address | Thousand Oaks, CA 91320-2752 |
Second Address | Thousand Oaks, CA 91320-2752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 23/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A92148 | (02) | CA |