Healthcare Provider Details

I. General information

NPI: 1265199160
Provider Name (Legal Business Name): HANA GROOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SPRING ST
LA MESA CA
91942-0263
US

IV. Provider business mailing address

6553 JAFFE CT APT 5
SAN DIEGO CA
92119-2157
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-9836-958718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: