Healthcare Provider Details

I. General information

NPI: 1376838680
Provider Name (Legal Business Name): JOHN GROTTING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 DIRECTORS PL STE 350
SAN DIEGO CA
92121-3834
US

IV. Provider business mailing address

4910 DIRECTORS PL STE 350
SAN DIEGO CA
92121-3834
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-9500
  • Fax:
Mailing address:
  • Phone: 858-571-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA144169
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA144169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: