Provider Demographics
NPI:1700935103
Name:GROSSI, TERESA A (NP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:A
Last Name:GROSSI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28212 KELLY JOHNSON PKWY
Mailing Address - Street 2:SUITE 245
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5084
Mailing Address - Country:US
Mailing Address - Phone:661-254-3686
Mailing Address - Fax:661-254-5671
Practice Address - Street 1:28212 KELLY JOHNSON PKWY
Practice Address - Street 2:SUITE 245
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5084
Practice Address - Country:US
Practice Address - Phone:661-254-3686
Practice Address - Fax:661-254-5671
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15948363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner