Groubert, Mark
Groubert, Mark is an sole proprietor health care provider with primary practice located at 5675 W Olympic Blvd , Los Angeles CA 90036-4712. He recently has only one registered license in Behavioral Health & Social Service Providers / Poetry Therapist, which is considered as his primary health care specialty. Groubert, Mark can be contacted via phone (323) 965-1365.Contact Information
Primary practice address
5675 W Olympic Blvd
Los Angeles CA 90036-4712
Phone: (323) 965-1365
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Poetry Therapist | 102X00000X | 60549 | California |
Profile Details
| NPI number | 1124539069 |
|---|---|
| LBN Legal business name | Groubert, Mark |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 18th, 2017 |
| Last updated | Mar 17th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124539069 | NPPES |
| California | Other | 60549 | RADT-1 |
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