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General NPI Number Information
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NPI Number | 1710218904
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Entity Type | Organization
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Legal Business Name | STEPHEN J. GROTH,MD,INC
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 32272 CAMINO CAPISTRANO SUITE A
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3742
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Country | US
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Telephone | 949-545-6930
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Fax | 949-545-6931
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Provider Business Mailing Address
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Address Line | 32272 CAMINO CAPISTRANO SUITE A
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3742
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Country | US
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Telephone | 949-545-6930
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Fax | 949-545-6931
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN JAMES GROTH
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Credential | MD
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Telephone | 949-545-6930
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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 | G36991
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License Number State | CA
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