Provider Demographics
NPI:1902253610
Name:OMOGROSSO, ROBERT K (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:OMOGROSSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:155 GLASSON WAY
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5723
Mailing Address - Country:US
Mailing Address - Phone:530-274-6761
Mailing Address - Fax:530-274-6175
Practice Address - Street 1:155 GLASSON WAY
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5723
Practice Address - Country:US
Practice Address - Phone:530-274-6761
Practice Address - Fax:530-274-6175
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A15941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine