Provider Demographics
NPI:1578051256
Name:OAXACA, GRISELDA P
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:P
Last Name:OAXACA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 N MESA ST STE 108
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5869
Mailing Address - Country:US
Mailing Address - Phone:915-613-3989
Mailing Address - Fax:915-503-2737
Practice Address - Street 1:5380 N MESA ST STE 108
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5869
Practice Address - Country:US
Practice Address - Phone:915-613-3989
Practice Address - Fax:915-503-2737
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty