Healthcare Provider Details

I. General information

NPI: 1245825066
Provider Name (Legal Business Name): JULIO GROVA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 HOLE AVE STE 17
RIVERSIDE CA
92505-2761
US

IV. Provider business mailing address

10800 HOLE AVE STE 17
RIVERSIDE CA
92505-2761
US

V. Phone/Fax

Practice location:
  • Phone: 951-588-8838
  • Fax: 951-351-2722
Mailing address:
  • Phone: 951-588-8838
  • Fax: 951-351-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: RHIANNON MILLER
Title or Position: OFFICE MANAGER
Credential:
Phone: 951-588-8838