Individual
MISS KELLY C GRUENLOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
417 HENRIETTA AVE, LOS OSOS, CA 93402-2519
(805) 239-3696
Mailing address
417 HENRIETTA AVE, LOS OSOS, CA 93402-2519
(805) 239-3696
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT30378
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT001411
—
CA
Enumeration date
12/05/2006
Last updated
12/10/2019
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