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General NPI Number Information
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NPI Number | 1255483525
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Entity Type | Organization
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Legal Business Name | GROSSMAN AND GROSSMAN MDS A MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 558 N VENTU PARK RD SUITE A
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-2718
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Country | US
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Telephone | 805-498-0240
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Fax |
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Provider Business Mailing Address
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Address Line | 558 N VENTU PARK RD SUITE A
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-2718
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Country | US
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Telephone | 805-498-0240
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT GROSSMAN
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Credential | M.D.
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Telephone | 805-498-0240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State |
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