Provider Demographics
NPI:1467779959
Name:JEFFREY D. GROSS, M.D., INC.
Entity Type:Organization
Organization Name:JEFFREY D. GROSS, M.D., INC.
Other - Org Name:CALIFORNIA COMPREHENSIVE INJURY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-6888
Mailing Address - Street 1:2701 HARBOR BLVD # 214
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5153
Mailing Address - Country:US
Mailing Address - Phone:714-378-1100
Mailing Address - Fax:714-378-1150
Practice Address - Street 1:27882 FORBES RD
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1267
Practice Address - Country:US
Practice Address - Phone:949-364-3888
Practice Address - Fax:949-364-6333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79394207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty