Healthcare Provider Details

I. General information

NPI: 1487230447
Provider Name (Legal Business Name): ENIOLA CHRISTINE GROS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ENIOLA GROS MD

II. Dates (important events)

Enumeration Date: 03/21/2021
Last Update Date: 05/27/2025
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 16TH ST
SANTA MONICA CA
90404-1249
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PT0002X
TaxonomyMedical Toxicology (Emergency Medicine) Physician
License NumberA195100
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA195100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: