Healthcare Provider Details

I. General information

NPI: 1205004652
Provider Name (Legal Business Name): IRWIN GROSSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SOLAR DR STE 135
OXNARD CA
93036-0635
US

IV. Provider business mailing address

2001 SOLAR DR STE 135
OXNARD CA
93036-0635
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-0616
  • Fax: 805-278-5570
Mailing address:
  • Phone: 805-988-0616
  • Fax: 805-278-5570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG19219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: