Provider Demographics
NPI:1467493726
Name:GRILLASCA PALOU, JORGE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:E
Last Name:GRILLASCA PALOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801222
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1222
Mailing Address - Country:US
Mailing Address - Phone:787-259-1934
Mailing Address - Fax:787-840-7734
Practice Address - Street 1:302 TORRE SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-259-1934
Practice Address - Fax:787-840-7734
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10497207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG65844Medicare UPIN
PR89294Medicare ID - Type Unspecified