DR. MARK LAND GROSSETETE (NPI# 1447592498) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447592498 |
| Entity Type | Individual |
| Full Name | DR. MARK LAND GROSSETETE |
| Credential | M.D., PH.D. |
| Practice Address |
117 Camino De Vida Ste 300 Santa Rosa NM 88435 |
| Mailing Address |
117 Camino De Vida Ste 300 Santa Rosa NM 88435-2267 |
| Practice Telephone | 5754724311 |
| Practice Fax Number | 5754724313 |
| Mailing Telephone | 5754724311 |
| Enumeration Date | 2013-03-17 |
| Last Update Date | 2018-08-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
MD2017-0779 | NM | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | NM | Student, Health Care |
| Street Address |
117 CAMINO DE VIDA STE 300 |
| City | SANTA ROSA |
| State | NM |
| Zip Code | 88435 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225695018 | Senora L Campos | Nurse Practitioner | 117 Camino De Vida Ste 300, Santa Rosa, NM 88435-2267 | 2019-05-28 |
| 1568946861 | Denia Victoria Guinart Gutierrez | Nurse Practitioner | 117 Camino De Vida Ste 300, Santa Rosa, NM 88435-2267 | 2018-09-21 |
| 1447760368 | Brian T Muniz | Physician Assistant | 117 Camino De Vida Ste 300, Santa Rosa, NM 88435-2267 | 2017-10-05 |
| 1366824963 | Mary M Kenyon | Nurse Practitioner | 117 Camino De Vida Ste 300, Santa Rosa, NM 88435-2267 | 2015-06-19 |
| 1811375769 | David Calkins, Md, LLC | Non-Pharmacy Dispensing Site | 117 Camino De Vida Ste 300, Santa Rosa, NM 88435-2267 | 2015-05-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326548322 | Katherine E Cerico | Physical Therapist | 1972 Historic Route 66, Santa Rosa, NM 88435 | 2018-02-15 |
| 1770017055 | Michael Montoya | Social Worker | 724 Park Lake Drive, Santa Rosa, NM 88435 | 2017-04-13 |
| 1962743534 | De Baca Family Practice Clinic | Clinic/Center | 552 Us Hwy 54, Santa Rosa, NM 88435 | 2013-03-07 |
| 1861728032 | Sonya Mireles | Counselor | 501 S Fourth St, Santa Rosa, NM 88435 | 2009-10-23 |
| 1255664231 | Victoria N Silva | Counselor | 501 S. Forth St., Santa Rosa, NM 88435 | 2009-09-09 |
| 1922039171 | Santa Rosa Medical Clinic | Internal Medicine | 533 Lake Dr, Santa Rosa, NM 88435 | 2006-07-06 |
| 1467750653 | Cassidy Ruth Huffman | Counselor | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435 | 2011-03-11 |
| 1134455306 | Anita Valencia | Counselor | 501 S Fourth St, Santa Rosa, NM 88435 | 2009-10-23 |
| 1841273554 | Dawn R Back | Physician Assistant | 117 Camino De Vida, Suite 300, Santa Rosa, NM 88435 | 2005-11-28 |
| 1952621070 | Erica Nicole Romero | Social Worker | 260 N 3rd St, Santa Rosa, NM 88435-2006 | 2010-06-11 |
| Find all providers in zip 88435 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588906663 | Stella Lai | Psychiatry & Neurology | 990 Sonoma Ave Ste 17, Santa Rosa, CA 95404 | 2013-03-26 |
| 1588793962 | Sidney Joseph Kurn | Psychiatry & Neurology | 95 Montgomery Dr Ste 126, Santa Rosa, CA 95404-6617 | 2007-03-03 |
| 1699861344 | Paul E Nicholas | Psychiatry & Neurology | 405 W College Ave Ste F, Santa Rosa, CA 95401-6506 | 2006-10-04 |
| 1336161835 | Joel M Reiter | Psychiatry & Neurology | 1103 Sonoma Ave, Santa Rosa, CA 95405-4805 | 2006-07-24 |
| 1346202975 | Zachary R Lewton | Psychiatry & Neurology | 1194 Montgomery Dr, Santa Rosa, CA 95405-4802 | 2006-04-06 |
| 1649471202 | Sea Jin Kim | Psychiatry & Neurology | 401 Bicentennial Way, Suite 200, Santa Rosa, CA 95403-2149 | 2007-05-30 |
| 1992837496 | Jerome Hsi-cheng Chin | Psychiatry & Neurology | 95 Montgomery Dr, Suite 102, Santa Rosa, CA 95404-6630 | 2007-03-10 |
| 1114066974 | Max Barnett Duncan | Psychiatry & Neurology | 3883 Airway Dr, Suite 201, Santa Rosa, CA 95403-1670 | 2007-02-06 |
| 1194894394 | Jet King-shing Ho | Psychiatry & Neurology | 401 Bicentennial Way, Santa Rosa, CA 95403-2149 | 2006-11-06 |
| 1053495036 | John F. Cassidy | Psychiatry & Neurology | 401 Bicentennial Way, Santa Rosa, CA 95403-2149 | 2006-10-25 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 88435 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.