Basic Information
| Provider Information | |||||||||
| NPI: | 1255483525 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GROSSMAN AND GROSSMAN MDS A MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 558 N VENTU PARK RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913202718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054980240 | ||||||||
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| Practice Location | |||||||||
| Address1: | 558 N VENTU PARK RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | THOUSAND OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913202718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054980240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 02/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | GROSSMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8054980240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 02/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
No ID Information.