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NPI Code Detail

MEDICARE: CYNTHIA MCDONALD GRUNBAUM

MEDICARE: CYNTHIA MCDONALD GRUNBAUM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1255506689
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA MCDONALD GRUNBAUM
Provider Business Mailing Address
First Line : 1841 LINWOOD ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-1943
Country : US
Telephone Number : 619-542-1438
Fax Number :
Provider Business Practice Location Address
First Line : 3050 ARMSTRONG ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92111-5702
Country : US
Telephone Number : 858-467-6700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2008
Last Update Date : 04/27/2008

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Directions to “ CYNTHIA MCDONALD GRUNBAUM ” Practice Location

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