Provider Demographics
NPI:1265820518
Name:GRUENEWALD, STEVEN (EDD, ATC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:GRUENEWALD
Suffix:
Gender:M
Credentials:EDD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 OLIVOS LN
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9543
Mailing Address - Country:US
Mailing Address - Phone:915-201-6700
Mailing Address - Fax:
Practice Address - Street 1:223 OLIVOS LN
Practice Address - Street 2:
Practice Address - City:NIPOMO
Practice Address - State:CA
Practice Address - Zip Code:93444-9543
Practice Address - Country:US
Practice Address - Phone:915-201-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer