Provider Demographics
NPI:1386757680
Name:GROVER, JEOTSNA (MD)
Entity type:Individual
Prefix:DR
First Name:JEOTSNA
Middle Name:
Last Name:GROVER
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14445 OLIVE VIEW DR
Mailing Address - Street 2:ROOM #3A101 OLIVE VIEW UCLA MEDICAL CENTER
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-1495
Mailing Address - Country:US
Mailing Address - Phone:818-364-4349
Mailing Address - Fax:818-364-3292
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:ROOM #3A101 OLIVE VIEW UCLA MEDICAL CENTER
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1495
Practice Address - Country:US
Practice Address - Phone:818-364-4349
Practice Address - Fax:818-364-3292
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA43590207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A435900Medicaid
E72050Medicare ID - Type Unspecified
CA00A435900Medicaid