MEDICARE: GROVER SURGICAL ARTS, LLC.

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
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1902461106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROVER SURGICAL ARTS, LLC.

Provider Business Mailing Address
First Line	:	20360 SW BIRCH ST STE 120
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1532
Country	:	US
Telephone Number	:	949-235-6199
Fax Number	:

Provider Business Practice Location Address
First Line	:	20360 SW BIRCH ST STE 120
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1532
Country	:	US
Telephone Number	:	949-235-6199
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SANJAY GROVER
Credential	:	MD
Telephone Number	:	949-235-6199

Provider Enumeration Date	:	05/03/2019
Last Update Date	:	05/03/2019

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