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General NPI Number Information
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NPI Number | 1013262104
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Entity Type | Individual
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Provider Name | SEANNA RAE GROB MD, MAS
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Gender | Female
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 101 THE CITY DR S
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City | ORANGE
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State | CA
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Zip | 92868-3201
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Country | US
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Telephone | 714-456-7183
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Fax |
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Provider Business Mailing Address
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Address Line | 243 CHARLES ST
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City | BOSTON
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State | MA
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Zip | 02114-3002
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Country | US
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Telephone | 617-523-7900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 265616
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | A148069
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License Number State | CA
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