Healthcare Provider Details

I. General information

NPI: 1568816916
Provider Name (Legal Business Name): JULIA W GROH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIA W YANG

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SHRINERS HOSPITALS FOR CHILDREN 909 S FAIR OAKS AVENUE
PASADENA CA
91105-2625
US

IV. Provider business mailing address

SHRINERS HOSPITALS FOR CHILDREN PO BOX 8500
PHILADELPHIA PA
19178-8113
US

V. Phone/Fax

Practice location:
  • Phone: 626-389-9300
  • Fax: 626-389-9336
Mailing address:
  • Phone: 813-281-8478
  • Fax: 813-281-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53581
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: