Provider Demographics
NPI:1023569373
Name:GRUER, DIMITRI (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:DIMITRI
Middle Name:
Last Name:GRUER
Suffix:
Gender:M
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24361 EL TORO RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-2756
Mailing Address - Country:US
Mailing Address - Phone:949-215-1957
Mailing Address - Fax:
Practice Address - Street 1:24361 EL TORO RD STE 105
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2756
Practice Address - Country:US
Practice Address - Phone:949-215-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16549171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist