Basic Information
| Provider Information | |||||||||
| NPI: | 1952496473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | BENNETT | ||||||||
| MiddleName: | RAYMOND | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 VIA DE LA VALLE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | DEL MAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920141992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12710 CARMEL COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921302153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992600 | ||||||||
| FaxNumber: | 6195266093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 01/13/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD25167 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.