Healthcare Provider Details

I. General information

NPI: 1215859038
Provider Name (Legal Business Name): DAWN MARIE GROOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 BEECH RD
NEWBURY PARK CA
91320-4707
US

IV. Provider business mailing address

172 BEECH RD
NEWBURY PARK CA
91320-4707
US

V. Phone/Fax

Practice location:
  • Phone: 805-794-8212
  • Fax:
Mailing address:
  • Phone: 805-794-8212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN73691
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: