Jesse Grullon
Physical Therapist - Sports
1031 W 34th St Ste 450
Los Angeles
, California 90089-2070
Jesse Grullon
Physical Therapist - Sports
1031 W 34th St Ste 450
Los Angeles
, California 90089-2070
(213) 740-0215
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About
Features
Specialties
- Physical Therapist - Sports
Languages spoken
- English
Location
First Address
- Jesse Grullon
- Po Box 31309
- Los Angeles, CA
- Zip : 90031-0309
- Phone : (213) 740-0215
Second Address
- Jesse Grullon
- 1031 W 34th St Ste 450
- Los Angeles, CA
- Zip : 90089-2070
- Phone : (213) 740-0215
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2251S0007X | Physical Therapist - Sports | PT298714 | CA |
National Provider Identifier
| NPI | 1518585512 |
|---|---|
| Provider Name | Jesse Grullon |
| First Address | Los Angeles, CA 90031-0309 |
| Second Address | Los Angeles, CA 90089-2070 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 07/07/2020 |
| Last Update Date | 22/03/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.