| Doctor Name: | BUKOLA GROSS |
| NPI Number: | 1003211566 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | NP95001547 |
| Business Practice Address: | 18522 Us Highway 18 Suite 208 Apple Valley, CA - 923072321 |
| Business Phone Number: | 7602427777 |
| Business Fax Number: | 7602429264 |
| Mailing Address: | 18564 Us Highway 18, Suite 105 APPLE VALLEY |
| State: | CA |
| Postal Code: | 923072312 |
| Phone Number: | 7602427777 |
| Fax Number: | 7602429264 |
| NPI Enumeration Date: | 10/27/2014 |
| NPI Last Update Date: | 10/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | NP95001547 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |