Provider Demographics
NPI:1790086361
Name:GARCIA, GRISSELL
Entity Type:Individual
Prefix:
First Name:GRISSELL
Middle Name:
Last Name:GARCIA
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 1:56 MARCUS GARVEY BLVD
Mailing Address - Street 2:#2 E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-5813
Mailing Address - Country:US
Mailing Address - Phone:347-645-7210
Mailing Address - Fax:
Practice Address - Street 1:56 MARCUS GARVEY BLVD
Practice Address - Street 2:#2 E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5813
Practice Address - Country:US
Practice Address - Phone:347-645-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292416-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse