Provider Demographics
NPI:1598104069
Name:GRUBER MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GRUBER MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FIROZEH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-370-1522
Mailing Address - Street 1:30131 TOWN CENTER DR STE 211
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2088
Mailing Address - Country:US
Mailing Address - Phone:949-415-5508
Mailing Address - Fax:760-875-7283
Practice Address - Street 1:1613 VISTA LUNA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-3661
Practice Address - Country:US
Practice Address - Phone:949-415-5508
Practice Address - Fax:760-875-7283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty