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NPI Code Detail

MEDICARE: CLARISSE GRIJALVA

MEDICARE: CLARISSE GRIJALVA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant3571NM

General Provider Information

NPI Number : 1548755267
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARISSE GRIJALVA
Provider Business Mailing Address
First Line : 4114 SANTIAGO WAY
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-7283
Country : US
Telephone Number : 575-519-2934
Fax Number :
Provider Business Practice Location Address
First Line : 2884 N ROADRUNNER PKWY
Second Line :
City : LAS CRUCES
State : NM
Zip : 88011-0853
Country : US
Telephone Number : 575-519-2934
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2018
Last Update Date : 06/25/2018

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Directions to “ CLARISSE GRIJALVA ” Practice Location

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