Healthcare Provider Details

I. General information

NPI: 1851356596
Provider Name (Legal Business Name): RAHUL GROVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8673 W PICO BLVD
LOS ANGELES CA
90035-2377
US

IV. Provider business mailing address

2763 WOODWARDIA DR
LOS ANGELES CA
90077-2120
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-3981
  • Fax: 310-652-3155
Mailing address:
  • Phone: 310-652-3981
  • Fax: 310-652-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC52335
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: