Healthcare Provider Details

I. General information

NPI: 1194251249
Provider Name (Legal Business Name): SEBASTIAN ORION GROOT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SAN PABLO AVE # 310
BERKELEY CA
94702-2498
US

IV. Provider business mailing address

1450 TREAT BLVD # 300
WALNUT CREEK CA
94597-2168
US

V. Phone/Fax

Practice location:
  • Phone: 510-985-5020
  • Fax:
Mailing address:
  • Phone: 925-952-2828
  • Fax: 925-952-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A16750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: