Provider Demographics
NPI:1659739704
Name:GRIGUTIS, OLENA L (PA)
Entity Type:Individual
Prefix:
First Name:OLENA
Middle Name:L
Last Name:GRIGUTIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:OLENA
Other - Middle Name:L
Other - Last Name:DELUCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:13203 N 103RD AVE
Mailing Address - Street 2:STE H5
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3032
Mailing Address - Country:US
Mailing Address - Phone:623-777-4747
Mailing Address - Fax:
Practice Address - Street 1:3615 S ROME ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7335
Practice Address - Country:US
Practice Address - Phone:480-771-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
AZ6332363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant