Provider Demographics
NPI:1417968496
Name:GRUBER, FIROZEH (MD)
Entity Type:Individual
Prefix:DR
First Name:FIROZEH
Middle Name:
Last Name:GRUBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 VISTA LUNA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3661
Mailing Address - Country:US
Mailing Address - Phone:949-415-5508
Mailing Address - Fax:760-875-7283
Practice Address - Street 1:30300 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1304
Practice Address - Country:US
Practice Address - Phone:949-240-2272
Practice Address - Fax:949-240-5869
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FHC70267FOtherMEDI CAL
FHC70267FOtherMEDI CAL
G69989Medicare UPIN