Provider Demographics
NPI:1790838134
Name:GROSS, STEVEN ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ALAN
Last Name:GROSS
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 1:6386 ALVARADO CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4906
Mailing Address - Country:US
Mailing Address - Phone:619-265-1237
Mailing Address - Fax:619-265-2142
Practice Address - Street 1:6386 ALVARADO CT
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4906
Practice Address - Country:US
Practice Address - Phone:619-265-1237
Practice Address - Fax:619-265-2142
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25708207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G257080Medicaid
CAGR0016720Medicaid
CAW7956AMedicare ID - Type Unspecified
CAW7956DMedicare ID - Type Unspecified
CA00G257080Medicaid