Individual
MARK GROUBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5675 W OLYMPIC BLVD, LOS ANGELES, CA 90036-4712
(323) 965-1365
Mailing address
2107 N VERMONT AVE APT 3, LOS ANGELES, CA 90027-1930
Taxonomy
Speciality
Code
Description
License number
State
102X00000X
Poetry Therapist
Primary
60549
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60549
RADT-1
CA
Enumeration date
10/18/2017
Last updated
03/17/2018
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