Provider Demographics
NPI:1700949112
Name:GROPEN, ELISSA (MD)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:GROPEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4954 ARLINGTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-2746
Mailing Address - Country:US
Mailing Address - Phone:951-684-8397
Mailing Address - Fax:951-684-2252
Practice Address - Street 1:4954 ARLINGTON AVE
Practice Address - Street 2:STE A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-2746
Practice Address - Country:US
Practice Address - Phone:951-684-8397
Practice Address - Fax:951-684-2252
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGM072AMedicare PIN