Individual
DR. STEPHEN JOHN GROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
554 DIAMOND ST, LAGUNA BEACH, CA 92651-3404
(949) 306-7383
(949) 497-1141
Mailing address
554 DIAMOND ST, LAGUNA BEACH, CA 92651-3404
(949) 306-7383
(949) 497-1141
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
G36991
CA
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
G36991
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G369910
—
CA
Enumeration date
12/05/2006
Last updated
10/06/2012
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