Provider Demographics
NPI:1992201859
Name:GROSSO, ASHTON R (DO)
Entity Type:Individual
Prefix:
First Name:ASHTON
Middle Name:R
Last Name:GROSSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ASHTON
Other - Middle Name:
Other - Last Name:NIELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1595 SOQUEL DR STE 400
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1724
Practice Address - Country:US
Practice Address - Phone:831-475-1111
Practice Address - Fax:831-476-5020
Is Sole Proprietor?:No
Enumeration Date:2018-03-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A19255208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist