Healthcare Provider Details

I. General information

NPI: 1336102359
Provider Name (Legal Business Name): JAMES SANTIAGO GRISOLIA M.D.INC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 3RD AVE STE 204
SAN DIEGO CA
92103-2130
US

IV. Provider business mailing address

4033 3RD AVE SUITE 410
SAN DIEGO CA
92103-2117
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-1155
  • Fax:
Mailing address:
  • Phone: 619-297-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG42884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: