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General NPI Number Information
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NPI Number | 1205681723
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Entity Type | Individual
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Provider Name | CERBELIO GILBERTO GRIJALVA REYES
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Gender | Male
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 680 WILSON AVE
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City | NOVATO
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State | CA
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Zip | 94947-3825
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Country | US
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Telephone | 415-532-7345
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Fax |
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Provider Business Mailing Address
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Address Line | 680 WILSON AVE
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City | NOVATO
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State | CA
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Zip | 94947-3825
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Country | US
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Telephone | 707-200-3696
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 142101
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License Number State | CA
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