Provider Demographics
NPI:1629158753
Name:GRINNELL, VICTORIA ANNE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ANNE
Last Name:GRINNELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:
Other - Last Name:GRINNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8044 CAMINITO GIANNA
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2910
Mailing Address - Country:US
Mailing Address - Phone:858-692-3181
Mailing Address - Fax:
Practice Address - Street 1:10990 SAN DIEGO MISSION RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2417
Practice Address - Country:US
Practice Address - Phone:619-641-4886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 109551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11587931OtherCAQH