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General NPI Number Information
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NPI Number | 1366463572
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Entity Type | Organization
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Legal Business Name | I. GROSSMAN M.D., INC.
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 2001 SOLAR DR STE 135
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City | OXNARD
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State | CA
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Zip | 93036-0635
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Country | US
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Telephone | 805-861-2200
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Fax | 805-861-2201
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Provider Business Mailing Address
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Address Line | 2001 SOLAR DR STE 135 P.O. BOX 6305
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City | OXNARD
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State | CA
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Zip | 93036-0635
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Country | US
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Telephone | 805-861-2200
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Fax | 805-861-2201
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. IRWIN GROSSMAN
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Credential | M.D.
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Telephone | 805-861-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G192191
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License Number State | CA
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