Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G7402 | CA |
NPI | 1225190598 |
---|---|
Provider Name | Mr. James Louis Grisez |
First Address | Arroyo Grande, CA 93420-3348 |
Second Address | Arroyo Grande, CA 93420-3348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 15/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A57867 | (02) |