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General NPI Number Information
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NPI Number | 1235128315
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Entity Type | Individual
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Provider Name | CLEMENS MARTIN GROSSKINSKY PHD, MD
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 320 LENNON LN LASSEN BUILDING, 2ND FLOOR, SUITE 5B
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City | WALNUT CREEK
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State | CA
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Zip | 94598-2419
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Country | US
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Telephone | 925-906-2329
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Fax | 925-906-4870
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Provider Business Mailing Address
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Address Line | 54 SAN GREGORIO CT
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City | DANVILLE
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State | CA
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Zip | 94526-1544
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Country | US
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Telephone | 614-266-9355
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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 | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 35066572G
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | G87868
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License Number State | CA
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