Provider Demographics
NPI:1023495975
Name:GRUBBS, JUSTIN CHRISTOPHER
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CHRISTOPHER
Last Name:GRUBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3631
Mailing Address - Country:US
Mailing Address - Phone:808-429-6979
Mailing Address - Fax:
Practice Address - Street 1:239 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-3631
Practice Address - Country:US
Practice Address - Phone:808-429-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA167111207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology