Healthcare Provider Details

I. General information

NPI: 1679743405
Provider Name (Legal Business Name): CHRISTOPHER GRUBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 RINALDI ST
MISSION HILLS CA
91345-1207
US

IV. Provider business mailing address

PO BOX 188
OAKDALE CA
95361-0188
US

V. Phone/Fax

Practice location:
  • Phone: 818-639-4333
  • Fax: 818-639-4332
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA99001
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: