Basic Information
| Provider Information | |||||||||
| NPI: | 1346981370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROVER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | REGISTERED NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3111 CAMINO DEL RIO N STE 1200 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921085747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192093696 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3853 ROSECRANS ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921103115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196928222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2022 | ||||||||
| LastUpdateDate: | 04/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | 756989 | CA | Y | Nursing Service Providers | Registered Nurse | Emergency |
No ID Information.