Healthcare Provider Details

I. General information

NPI: 1841430535
Provider Name (Legal Business Name): GROBLER ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S EUCLID AVE STE C
UPLAND CA
91786-6665
US

IV. Provider business mailing address

350 S EUCLID AVE STE C
UPLAND CA
91786-6665
US

V. Phone/Fax

Practice location:
  • Phone: 909-591-6575
  • Fax: 909-591-8986
Mailing address:
  • Phone: 909-591-6575
  • Fax: 909-591-8986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA89047
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA89047
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA89047
License Number StateCA

VIII. Authorized Official

Name: NICOLAAS M GROBLER
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 909-591-6575