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General NPI Number Information
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NPI Number | 1134370620
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Entity Type | Organization
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Legal Business Name | JAY GROSS, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 10/17/2012
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Provider Practice Location Address
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Address Line | 2222 SANTA MONICA BLVD SUITE 107
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City | SANTA MONICA
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State | CA
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Zip | 90404-2304
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Country | US
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Telephone | 310-496-3770
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Fax | 310-496-3767
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Provider Business Mailing Address
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Address Line | 2222 SANTA MONICA BLVD SUITE 107
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City | SANTA MONICA
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State | CA
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Zip | 90404-2304
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Country | US
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Telephone | 310-496-3770
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Fax | 310-496-3767
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RACHEL GRACIA
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Credential |
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Telephone | 310-496-3770
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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 | G36307
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License Number State | CA
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