MEDICARE: DANIEL E. GROSZ MD A PROFESSIONAL CORPORATION

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	305R00000X	Preferred Provider Organization	A49772	CA

General Provider Information

NPI Number	:	1912158312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL E. GROSZ MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	16661 VENTURA BLVD STE 603
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-4829
Country	:	US
Telephone Number	:	818-386-0500
Fax Number	:	818-386-2019

Provider Business Practice Location Address
First Line	:	16661 VENTURA BLVD STE 603
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-4829
Country	:	US
Telephone Number	:	818-386-0500
Fax Number	:	818-386-2019

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL E GROSZ
Credential	:	MD
Telephone Number	:	818-386-0500

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	06/26/2009

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