Provider Demographics
NPI:1922202027
Name:GRUVER, ERIC WAYNE X (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WAYNE
Last Name:GRUVER
Suffix:X
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17772 17TH ST
Mailing Address - Street 2:STE 106
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1944
Mailing Address - Country:US
Mailing Address - Phone:714-544-4434
Mailing Address - Fax:714-544-4996
Practice Address - Street 1:17772 17TH ST
Practice Address - Street 2:STE 106
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1944
Practice Address - Country:US
Practice Address - Phone:714-544-4434
Practice Address - Fax:714-544-4996
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5246103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic