Healthcare Provider Details

I. General information

NPI: 1952745861
Provider Name (Legal Business Name): ADRIAN SAUL GROW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E DYER RD STE 120
SANTA ANA CA
92705-5634
US

IV. Provider business mailing address

1221 E DYER RD STE 120
SANTA ANA CA
92705-5634
US

V. Phone/Fax

Practice location:
  • Phone: 949-250-0488
  • Fax:
Mailing address:
  • Phone: 949-250-0488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: