Provider Demographics
NPI:1790978310
Name:ELISSA GROPEN MD
Entity Type:Organization
Organization Name:ELISSA GROPEN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROPEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-684-8397
Mailing Address - Street 1:4954 ARLINGTON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2746
Mailing Address - Country:US
Mailing Address - Phone:951-684-8397
Mailing Address - Fax:951-684-2252
Practice Address - Street 1:4954 ARLINGTON AVE
Practice Address - Street 2:STE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2746
Practice Address - Country:US
Practice Address - Phone:951-684-8397
Practice Address - Fax:951-684-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty