Healthcare Provider Details

I. General information

NPI: 1366463572
Provider Name (Legal Business Name): I. GROSSMAN M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/07/2008
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 P.O. BOX 6305
OXNARD CA
93036-0635
US

V. Phone/Fax

Practice location:
  • Phone: 805-861-2200
  • Fax: 805-861-2201
Mailing address:
  • Phone: 805-861-2200
  • Fax: 805-861-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG192191
License Number StateCA

VIII. Authorized Official

Name: DR. IRWIN GROSSMAN
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 805-861-2200