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General NPI Number Information
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NPI Number | 1497244784
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Entity Type | Organization
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Legal Business Name | DAYNE MICHAEL GROVE NATUROPATHIC DOCTOR INC
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Dates
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Enumeration Date | 05/02/2018
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | 2664 NEWPORT BLVD
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City | COSTA MESA
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State | CA
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Zip | 92627-4641
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Country | US
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Telephone | 949-631-5226
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Fax |
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Provider Business Mailing Address
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Address Line | 257 BROADWAY
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City | COSTA MESA
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State | CA
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Zip | 92627-2817
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Country | US
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Telephone | 949-572-8288
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAYNE MICHAEL GROVE
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Credential | ND, LAC
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Telephone | 949-572-8288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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