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General NPI Number Information
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NPI Number | 1245825066
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Entity Type | Organization
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Legal Business Name | JULIO GROVA
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 10800 HOLE AVE STE 17
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City | RIVERSIDE
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State | CA
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Zip | 92505-2761
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Country | US
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Telephone | 951-588-8838
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Fax | 951-351-2722
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Provider Business Mailing Address
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Address Line | 10800 HOLE AVE STE 17
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City | RIVERSIDE
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State | CA
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Zip | 92505-2761
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Country | US
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Telephone | 951-588-8838
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Fax | 951-351-2722
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RHIANNON MILLER
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Credential |
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Telephone | 951-588-8838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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