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General NPI Number Information
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NPI Number | 1265442248
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Entity Type | Individual
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Provider Name | RUTH DIANE GROSS PHD
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Gender | Female
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1220 UNIVERSITY DRIVE SUITE 103
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City | MENLO PARK
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State | CA
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Zip | 94025-4265
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Country | US
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Telephone | 650-361-0669
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 CHELSEA WAY
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City | REDWOOD CITY
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State | CA
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Zip | 94061-3666
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Country | US
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Telephone | 650-363-8090
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Fax | 650-363-8090
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY15281
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License Number State | CA
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