Provider Demographics
NPI:1437917713
Name:GRIMARD, LEANDRE
Entity Type:Individual
Prefix:
First Name:LEANDRE
Middle Name:
Last Name:GRIMARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4076 MARCIL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MONTREAL
Mailing Address - State:QUBEC
Mailing Address - Zip Code:H4A2Z6
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41-1347 KALANIANAOLE HIGHWAY
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1247
Practice Address - Country:US
Practice Address - Phone:808-259-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program