# JAY GROSS, M.D., A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134370620
- **Authorized official:** RACHEL GRACIA (OFFICE MANAGER)
- **Authorized official phone:** (310) 496-3770

## Contact information

- **Practice address:** 2222 SANTA MONICA BLVD, SUITE 107, SANTA MONICA, CA 90404-2304
- **Practice address phone:** (310) 496-3770
- **Practice address fax:** (310) 496-3767
- **Mailing address:** 2222 SANTA MONICA BLVD, SUITE 107, SANTA MONICA, CA 90404-2304
- **Mailing address phone:** (310) 496-3770
- **Mailing address fax:** (310) 496-3767

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | G36307 | CA | Yes |

## Other

- **Enumeration date:** 10/02/2008
- **Last updated:** 10/17/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G373070 | — | CA |