Frederick Grubstad II

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95019498 Issued in CA

Practice address

1777 Buckman Springs Rd
Campo, CA 91906-2022

Phone

(619) 478-5696

Fax

(619) 478-2404

NPI assigned

Jul 11, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• San Diego Freedom Ranch, Inc.

  • Substance Abuse Rehabilitation Facility
  • Campo, CA
  • NPI 1093937591
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1477039667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14360 RIOS CANYON RD SPC 76",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920212735",
            "telephone_number": "619-249-3746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 BUCKMAN SPRINGS RD",
            "city": "CAMPO",
            "state": "CA",
            "postal_code": "919062022",
            "telephone_number": "619-478-5696",
            "fax_number": "619-478-2404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUBSTAD",
        "first_name": "FREDERICK",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-07-11",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95019498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James David Elkins
• Charles Johnson Ethelbah, CMPSS
• Robert Filice, RADT
• Heidi Michelle Gonzalez, RADT
• Nicolas Gonzalez, RADT
• Roxanne Marie Hagan
• Travis Hamblin, CMPSS
• Mason David Han, RADT
• Anthony Jacob Hernandez, RADT
• Omar Hernandez, RADT

• Psychiatric/Mental Health Nurse Practitioner in Campo, CA
• Providers in Campo, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.