Healthcare Provider Details

I. General information

NPI: 1932404738
Provider Name (Legal Business Name): JAY GRONE RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21050 CALIFA ST. #100
WOODLAND HILLS CA
91367
US

IV. Provider business mailing address

1630 MADISON ST SE
ALBANY OR
97322-6734
US

V. Phone/Fax

Practice location:
  • Phone: 818-462-0000
  • Fax:
Mailing address:
  • Phone: 541-981-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number16233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: