Provider Demographics
NPI:1629110713
Name:GROSSI, PHILIP ALBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ALBERT
Last Name:GROSSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:879 NEAL COMMONS
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3425 S BASCOM AVE
Practice Address - Street 2:STE C
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7300
Practice Address - Country:US
Practice Address - Phone:408-559-9300
Practice Address - Fax:408-907-3901
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG123892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G123890Medicaid
CAA 38651Medicare UPIN
CA00G123890Medicaid