Healthcare Provider Details

I. General information

NPI: 1457936890
Provider Name (Legal Business Name): ANA MARIA GRISALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 E IMPERIAL HWY
LYNWOOD CA
90262-2659
US

IV. Provider business mailing address

3680 E IMPERIAL HWY STE 220
LYNWOOD CA
90262-2663
US

V. Phone/Fax

Practice location:
  • Phone: 323-769-7174
  • Fax:
Mailing address:
  • Phone: 323-769-7174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: