Provider Demographics
NPI:1629757927
Name:GROSS, RENEE LIA
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LIA
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 S OXFORD AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2929
Mailing Address - Country:US
Mailing Address - Phone:303-386-5446
Mailing Address - Fax:
Practice Address - Street 1:831 S OXFORD AVE APT 9
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-2929
Practice Address - Country:US
Practice Address - Phone:303-386-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula