| Dr Gross Medical Center, Inc | |
|
1718 Colorado Blvd Los Angeles CA 90041 | |
| (323) 561-3006 | |
| (323) 561-3062 |
| Full Name | Dr Gross Medical Center, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1718 Colorado Blvd, Los Angeles, California |
| Authorized Official Name and Position | Benjamin Gross (OWNER /MEDICAL DIRECTOR) |
| Authorized Official Contact | 3235613006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Gross Medical Center, Inc 1718 Colorado Blvd Los Angeles CA 90041 Ph: (323) 561-3006 | Dr Gross Medical Center, Inc 1718 Colorado Blvd Los Angeles CA 90041 Ph: (323) 561-3006 |
| NPI Number | 1538869037 |
|---|---|
| Provider Enumeration Date | 03/06/2023 |
| Last Update Date | 03/06/2023 |
| Certification Date | 03/04/2023 |
| Medicare PECOS PAC ID | 1355706219 |
|---|---|
| Medicare Enrollment ID | O20230427001480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538869037 | NPI | - | NPPES |
| G41777 | Other | CA | MEDICAL BOARD OF CALIFORNIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Benjamin Gross |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1124053665 PECOS PAC ID: 1759308984 Enrollment ID: I20051027000604 |
| Provider Name | Antuan Kiley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619140050 PECOS PAC ID: 4880798636 Enrollment ID: I20090512000450 |
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