Individual
RYAN GROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2823 FRESNO ST, FRESNO, CA 93721-1324
(559) 499-6440
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
(559) 443-2681
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
56160
CA
363AM0700X
Medical Physician Assistant
Primary
56160
CA
363AS0400X
Surgical Physician Assistant
56160
CA
Other
Enumeration date
04/08/2017
Last updated
01/16/2020
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