Provider Demographics
NPI:1225190598
Name:GRISEZ, JAMES LOUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LOUIS
Last Name:GRISEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PLASTIC
Other - Middle Name:RECONHAND
Other - Last Name:SURGERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 STATION WAY
Mailing Address - Street 2:STE 200B
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3348
Mailing Address - Country:US
Mailing Address - Phone:805-489-1409
Mailing Address - Fax:805-489-1290
Practice Address - Street 1:200 STATION WAY
Practice Address - Street 2:STE 200B
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3348
Practice Address - Country:US
Practice Address - Phone:805-489-1409
Practice Address - Fax:805-489-1290
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74022086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A57867Medicare UPIN