Healthcare Provider Details

I. General information

NPI: 1023646981
Provider Name (Legal Business Name): RICHARD ROBERT GRUNERT CACT 2215167-2
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ALAMEDA DE LAS PULGAS
SAN MATEO CA
94403-1269
US

IV. Provider business mailing address

668 CHEVY CHASE WAY
HAYWARD CA
94544-7230
US

V. Phone/Fax

Practice location:
  • Phone: 650-670-7714
  • Fax:
Mailing address:
  • Phone: 650-921-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number2215767-2
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberR1341210319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: