Individual
MR. MARK DOUGLAS GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
24785 STEWART ST RM 201, LOMA LINDA, CA 92350-1721
(909) 558-8161
Mailing address
24785 STEWART ST RM 201, LOMA LINDA, CA 92350-1721
(909) 558-7295
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA65295
CA
363AS0400X
Surgical Physician Assistant
Primary
PA65295
CA
Other
Enumeration date
08/21/2024
Last updated
05/14/2025
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