KENNETH E. GRULLON (NPI# 1801974977) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801974977 |
| Entity Type | Individual |
| Full Name | KENNETH E. GRULLON |
| Credential | MD |
| Practice Address |
3400 Delta Fair Blvd Antioch CA 94509-4004 |
| Mailing Address |
1800 Harrison St Fl 7 Oakland CA 94612-3429 |
| Practice Telephone | 9257795000 |
| Mailing Telephone | 5106256262 |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | G76376 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G763760 | 05 |
| Street Address |
3400 DELTA FAIR BLVD |
| City | ANTIOCH |
| State | CA |
| Zip Code | 94509-4004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215929914 | Barbara A Rhoades | Nurse Practitioner | 3400 Delta Fair Blvd, Antioch, CA 94509-4004 | 2005-08-18 |
| 1962936849 | Nardip Singh | Pharmacist | 3400 Delta Fair Blvd, Antioch, CA 94509-4004 | 2017-04-17 |
| 1649704743 | Anh X Nguyen | Pharmacist | 3400 Delta Fair Blvd, Antioch, CA 94509-4004 | 2017-04-14 |
| 1104359918 | Borey Som | Pharmacist | 3400 Delta Fair Blvd, Antioch, CA 94509-4004 | 2017-04-07 |
| 1790005015 | Elizabeth Seidler | Dermatology | 3400 Delta Fair Blvd, Antioch, CA 94509-4004 | 2010-06-09 |
| 1699091793 | Allison Townsend Hampton | Pediatrics | 3400 Delta Fair Blvd, Department of Pediatrics, Antioch, CA 94509-4004 | 2010-04-14 |
| 1063746998 | Athena Panzar | Counselor | 3400 Delta Fair Blvd, Antioch, CA 94509-4004 | 2009-09-24 |
| 1083859888 | Philip Song | Dermatology | 3400 Delta Fair Blvd, Antioch, CA 94509-4004 | 2008-12-08 |
| 1033319215 | Sanaz Stacy Aboutalebi-simon | Optometrist | 3400 Delta Fair Blvd, The Permanente Medical Group, Inc., Antioch, CA 94509-4004 | 2007-07-24 |
| 1700099264 | Derek S Mongold | Family Medicine | 3400 Delta Fair Blvd, Antioch, CA 94509-4004 | 2007-05-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932733243 | A Step Above, LLC | Clinic/Center | 3648 Delta Fair Blvd., Antioch, CA 94509 | 2020-02-25 |
| 1134751167 | Dr. Jeffrey A Saladin, Dental Corporation | Dentist | 3600 Delta Fair Blvd, Antioch, CA 94509 | 2020-02-07 |
| 1962040865 | Melay Goitom | Behavioral Analyst | 3104 Delta Fair Boulevard, Antioch, CA 94509 | 2019-12-11 |
| 1518525062 | James Joseph Cook | Counselor | 624 W. 14th Street B, Antioch, CA 94509 | 2019-05-30 |
| 1922576438 | Wazma Matiee | Behavioral Analyst | 2009 Asilomar Dr., Antioch, CA 94509 | 2018-11-02 |
| 1346722360 | Dharma Rachelle Yancy | Behavioral Analyst | 3401 Delta Fair Blvd, Antioch, CA 94509 | 2018-09-06 |
| 1912489931 | Cristian Cruz | Behavioral Analyst | 3100-3104 Delta Fair Blvd, Antioch, CA 94509 | 2018-09-06 |
| 1780174052 | Melissa Sue Rossi | Counselor | 3701 Lone Tree Way Ste 7a, Antioch, CA 94509 | 2018-05-13 |
| 1033638085 | Elizabeth Marie Artola | Counselor | 1915 D Street, Antioch, CA 94509 | 2017-09-11 |
| 1144748690 | Andrea Michelle Newberry | Counselor | 55 E.18th St, Antioch, CA 94509 | 2017-09-05 |
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| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093157984 | Jessica Lennon | Obstetrics & Gynecology | 4053 Lone Tree Way Ste 100, Antioch, CA 94531-6210 | 2013-07-22 |
| 1609107747 | Debra L Stewart, Inc | Obstetrics & Gynecology | 3700 Sunset Ln Ste 7, Antioch, CA 94509-6123 | 2010-01-28 |
| 1154347615 | Kyla Ai-lan Yee | Obstetrics & Gynecology | 4053 Lone Tree Way, #101, Antioch, CA 94531-6200 | 2006-07-15 |
| 1649236522 | Young Min Kim | Obstetrics & Gynecology | 3724 Lone Tree Way, Suite A, Antioch, CA 94509 | 2006-04-21 |
| 1225421589 | Daniel L Zimmerman Md, Inc. | Obstetrics & Gynecology | 3737 Lone Tree Way, Antioch, CA 94509-6065 | 2015-03-11 |
| 1396074373 | Nicole Kathryn Shelton | Obstetrics & Gynecology | 4501 Sand Creek Rd, Antioch, CA 94531-8687 | 2009-12-21 |
| 1942475710 | Elmira Manoucheri | Obstetrics & Gynecology | 4501 Sand Creek Rd, Antioch, CA 94531-8687 | 2008-04-23 |
| 1124201223 | Anahita Latorra | Obstetrics & Gynecology | 4501 Sand Creek Rd, Antioch, CA 94531-8687 | 2007-12-11 |
| 1619041225 | Vivien L. Tin | Obstetrics & Gynecology | 3400 Delta Fair Blvd, Antioch, CA 94509-4004 | 2006-11-17 |
| 1538231337 | Darcy Page Baird | Obstetrics & Gynecology | 5601 Deer Valley Rd, Antioch, CA 94531-8577 | 2006-11-15 |
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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.