1588764187 NPI number — DR. JERI M GRUENES D.P.M.

Table of content: DR. JERI M GRUENES D.P.M. (NPI 1588764187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588764187 NPI number — DR. JERI M GRUENES D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRUENES
Provider First Name:
JERI
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1588764187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 541
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORBA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92885-0541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-985-9168
Provider Business Mailing Address Fax Number:
714-990-2855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1041 E YORBA LINDA BLVD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PLACENTIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92870-3728
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-985-9168
Provider Business Practice Location Address Fax Number:
714-985-9161
Provider Enumeration Date:
09/23/2006

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: 213ES0103X , with the licence number:  E4532 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00470568 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 000E45320 . This is a "BCBS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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