Healthcare Provider Details

I. General information

NPI: 1639784978
Provider Name (Legal Business Name): DOCTOR CHARLES GRUVER, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S ROBERTSON BLVD
LOS ANGELES CA
90035-1613
US

IV. Provider business mailing address

813 S ADAMS ST
GLENDALE CA
91205-2527
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-6937
  • Fax:
Mailing address:
  • Phone: 818-415-3827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES GRUVER
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 818-415-3827