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NPI Code Detail

MEDICARE: DR. MITCHELL GROSS M.D.

MEDICARE: DR. MITCHELL GROSS M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistA55762CA
2207RX0202XMedical Oncology PhysicianA55762CA

General Provider Information

NPI Number : 1548298656
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MITCHELL GROSS M.D.
Provider Business Mailing Address
First Line : PO BOX 31309
Second Line :
City : LOS ANGELES
State : CA
Zip : 90031-0309
Country : US
Telephone Number : 310-272-7640
Fax Number :
Provider Business Practice Location Address
First Line : 12414 EXPOSITION BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90064-1016
Country : US
Telephone Number : 310-272-7640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 11/27/2023

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