Provider Demographics
NPI:1588764187
Name:GRUENES, JERI M (DPM)
Entity type:Individual
Prefix:DR
First Name:JERI
Middle Name:M
Last Name:GRUENES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-0541
Mailing Address - Country:US
Mailing Address - Phone:714-985-9168
Mailing Address - Fax:714-990-2855
Practice Address - Street 1:1041 E YORBA LINDA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3728
Practice Address - Country:US
Practice Address - Phone:714-985-9168
Practice Address - Fax:714-985-9161
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4532213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00470568OtherRAILROAD MEDICARE
CA000E45320OtherBCBS
CAU98960Medicare UPIN
CAP00470568OtherRAILROAD MEDICARE