Healthcare Provider Details

I. General information

NPI: 1427939206
Provider Name (Legal Business Name): HELENA MARSHALL GRILLO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 D AVE
CORONADO CA
92118-1318
US

IV. Provider business mailing address

269 D AVE
CORONADO CA
92118-1318
US

V. Phone/Fax

Practice location:
  • Phone: 619-888-9775
  • Fax:
Mailing address:
  • Phone: 619-888-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86392301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: