Healthcare Provider Details

I. General information

NPI: 1659328169
Provider Name (Legal Business Name): JEANNE K. GROMER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10862 CALLE VERDE
LA MESA CA
91941-7338
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 619-670-5400
  • Fax:
Mailing address:
  • Phone: 619-660-1832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG74273
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberG74273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: