Provider Demographics
NPI:1790925444
Name:GRIS, CARLOS (MA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:GRIS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 N 16TH ST
Mailing Address - Street 2:# 120-491
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5547
Mailing Address - Country:US
Mailing Address - Phone:602-864-1377
Mailing Address - Fax:
Practice Address - Street 1:7000 N 16TH ST
Practice Address - Street 2:# 120-491
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5547
Practice Address - Country:US
Practice Address - Phone:602-864-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator