1699805846 NPI number — JANEL M GROBES MFT

Table of content: JANEL M GROBES MFT (NPI 1699805846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699805846 NPI number — JANEL M GROBES MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GROBES
Provider First Name:
JANEL
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699805846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 WEST BASELINE ROAD
Provider Second Line Business Mailing Address:
BOX 400
Provider Business Mailing Address City Name:
LA VERNE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-593-2581
Provider Business Mailing Address Fax Number:
909-596-3567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 GRAVES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEMEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91770-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-280-6510
Provider Business Practice Location Address Fax Number:
626-288-1026
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7544A , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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