Healthcare Provider Details

I. General information

NPI: 1356321640
Provider Name (Legal Business Name): FRANKLIN B. GROSSMAN, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CORTE SEVILLA
SAN CLEMENTE CA
92673-6872
US

IV. Provider business mailing address

9 CORTE SEVILLA
SAN CLEMENTE CA
92673-6872
US

V. Phone/Fax

Practice location:
  • Phone: 949-366-5288
  • Fax:
Mailing address:
  • Phone: 949-366-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANKLIN BARRY GROSSMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-366-5288