Healthcare Provider Details

I. General information

NPI: 1487745808
Provider Name (Legal Business Name): MICHAEL J GRUBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 E LA PALMA AVE
ANAHEIM CA
92806-2020
US

IV. Provider business mailing address

3460 E LA PALMA AVE
ANAHEIM CA
92806-2020
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-6450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number108707
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number108707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: