Provider Demographics
NPI:1639231640
Name:GRULLON, GRISELDA (MD)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:GRULLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-2926
Mailing Address - Country:US
Mailing Address - Phone:561-586-6300
Mailing Address - Fax:561-586-6389
Practice Address - Street 1:4913 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-2926
Practice Address - Country:US
Practice Address - Phone:561-586-6300
Practice Address - Fax:561-586-6389
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80991208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics