Healthcare Provider Details

I. General information

NPI: 1558595991
Provider Name (Legal Business Name): KIMBERLY GRIZZELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 OAK ST
SAN FRANCISCO CA
94117-2217
US

IV. Provider business mailing address

1140 OAK ST
SAN FRANCISCO CA
94117-2217
US

V. Phone/Fax

Practice location:
  • Phone: 415-431-8252
  • Fax: 415-431-3195
Mailing address:
  • Phone: 415-431-8252
  • Fax: 415-431-3195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: