Healthcare Provider Details

I. General information

NPI: 1255459020
Provider Name (Legal Business Name): JAMES L GRISEZ, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STATION WAY STE 200B
ARROYO GRANDE CA
93420-3348
US

IV. Provider business mailing address

200 STATION WAY STE 200B
ARROYO GRANDE CA
93420-3348
US

V. Phone/Fax

Practice location:
  • Phone: 805-489-1409
  • Fax: 895-489-1290
Mailing address:
  • Phone: 805-489-1409
  • Fax: 895-489-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE MADELINE GRISEZ
Title or Position: ADMINISTRATOR
Credential: PHD
Phone: 805-489-1409