Provider Demographics
NPI:1831247626
Name:FOSTER GROVES, COLETTE (MD)
Entity type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:
Last Name:FOSTER GROVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:COLETTE
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5971 VENICE BLVD
Mailing Address - Street 2:KAISER DERMATOLOGY 4TH FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1713
Mailing Address - Country:US
Mailing Address - Phone:323-857-2000
Mailing Address - Fax:323-857-2314
Practice Address - Street 1:6041 CADILLAC AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1702
Practice Address - Country:US
Practice Address - Phone:323-857-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61801207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology