Most Relevant Information
Provider Data
| NPI Number: | 1003211566 |
| Provider Name: | BUKOLA GROSS |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | NP95001547 |
Most Important Dates
| Enumeration Date: | 10/27/2014 |
| Last Updated: | 11/07/2022 |
Provider Practice Location
13010 HESPERIA RD STE 501
VICTORVILLE
CA
923958315
Practice Location Phone/Fax
| Phone: | 7608813717 |
| Fax: |
Provider Mailing Location
19111 TOWN CENTER DR
APPLE VALLEY
CA
923088989
Provider Mailing Phone/Fax
| Phone: | 7602427777 |
| Fax: |