Healthcare Provider Details

I. General information

NPI: 1144906330
Provider Name (Legal Business Name): DORY ELIZABETH GROBECK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 VILLA LA JOLLA DR STE C227
LA JOLLA CA
92037-1712
US

IV. Provider business mailing address

8950 VILLA LA JOLLA DR STE C227
LA JOLLA CA
92037-1712
US

V. Phone/Fax

Practice location:
  • Phone: 619-841-2627
  • Fax: 833-455-7977
Mailing address:
  • Phone: 619-841-2627
  • Fax: 833-455-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68531
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9783
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: