Provider Demographics
NPI:1821157033
Name:GRIMALDI, JOHN ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:GRIMALDI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:450 4TH AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4426
Mailing Address - Country:US
Mailing Address - Phone:619-420-0201
Mailing Address - Fax:619-425-7795
Practice Address - Street 1:450 4TH AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4426
Practice Address - Country:US
Practice Address - Phone:619-420-0201
Practice Address - Fax:619-425-7795
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2023-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A11355208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology