Organization Name: | MICHAEL JACK GROSSMAN, M.D., INC |
NPI Number: | 1952543316 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL J GROSSMAN (DIRECTOR) |
Mailing Address: | 2171 Campus Dr Suite 120 Irvine |
State: | CA US |
Postal Code: | 926121422 |
Phone Number: | 8669464071 |
Fax Number: | 8669464072 |
NPI Enumeration Date: | 04/01/2009 |
NPI Last Update Date: | 04/01/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | G33405 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |