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NPI Code Detail

MEDICARE: MRS. KRISTIN GROSS PH.D.

MEDICARE: MRS. KRISTIN GROSS PH.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
1103G00000XClinical Neuropsychologist19304CA

General Provider Information

NPI Number : 1770620593
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIN GROSS PH.D.
Provider Business Mailing Address
First Line : 1215 OXFORD ST
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1422
Country : US
Telephone Number : 510-530-1676
Fax Number :
Provider Business Practice Location Address
First Line : 1215 OXFORD ST
Second Line :
City : BERKELEY
State : CA
Zip : 94709-1422
Country : US
Telephone Number : 510-530-1676
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 06/26/2009

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Directions to “ MRS. KRISTIN GROSS PH.D.” Practice Location

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