Individual
ADAM GROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
25115 AVENUE STANFORD STE A100, VALENCIA, CA 91355-1290
(818) 241-6780
Mailing address
25115 AVENUE STANFORD STE A100, VALENCIA, CA 91355-1290
(818) 241-6780
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PJ572569
DRIVERS LICENSE
OH
Enumeration date
05/12/2020
Last updated
05/12/2020
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