Provider Demographics
NPI:1376761197
Name:GRILLO, MARIA C (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:C
Last Name:GRILLO
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:C
Other - Last Name:RIZZOTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:29 HEREFORD LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1682
Mailing Address - Country:US
Mailing Address - Phone:508-378-9829
Mailing Address - Fax:
Practice Address - Street 1:250 POND ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5351
Practice Address - Country:US
Practice Address - Phone:781-848-5353
Practice Address - Fax:781-348-2408
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist