Provider Demographics
NPI:1598450272
Name:GRIMALDO, BLANCA MONICA
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:MONICA
Last Name:GRIMALDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1454 E DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-6512
Mailing Address - Country:US
Mailing Address - Phone:480-415-1535
Mailing Address - Fax:
Practice Address - Street 1:1454 E DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-6512
Practice Address - Country:US
Practice Address - Phone:480-415-1535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ010805171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter