Healthcare Provider Details

I. General information

NPI: 1265866487
Provider Name (Legal Business Name): MONICA GROVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 TROUSDALE DR FL 5
BURLINGAME CA
94010-4506
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 650-652-8787
  • Fax: 650-652-8770
Mailing address:
  • Phone: 650-652-8787
  • Fax: 650-652-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA136035
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA136035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: