Individual
GABRIEL JUSTIN GROOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2990
Mailing address
280 ALDERGROVE RD, ARCATA, CA 95521-8902
(707) 845-6735
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
95119299
CA
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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