Provider Demographics
NPI:1235271529
Name:GRUVER, G JAMES J G
Entity Type:Individual
Prefix:MR
First Name:G JAMES
Middle Name:J G
Last Name:GRUVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N STATE COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806
Mailing Address - Country:US
Mailing Address - Phone:714-758-1175
Mailing Address - Fax:714-758-9201
Practice Address - Street 1:415 N STATE COLLEGE BLVD
Practice Address - Street 2:ADP MEDICAL GROUP
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806
Practice Address - Country:US
Practice Address - Phone:714-758-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13875103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR16779Medicare UPIN
CACP13875Medicare PIN