Healthcare Provider Details

I. General information

NPI: 1083744916
Provider Name (Legal Business Name): G AND J GROSS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 N ROXBURY DR
BEVERLY HILLS CA
90210-5001
US

IV. Provider business mailing address

433 N ROXBURY DR
BEVERLY HILLS CA
90210-5001
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-6123
  • Fax: 310-273-5339
Mailing address:
  • Phone: 310-271-6123
  • Fax: 310-273-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY51055
License Number StateCA

VIII. Authorized Official

Name: JEFFREY GROSS
Title or Position: PRESIDENT
Credential:
Phone: 310-271-6123