Provider Demographics
NPI:1922299130
Name:GRIJALVA, MICHAEL MARTIN
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MARTIN
Last Name:GRIJALVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 MENAUL BLVD NE
Mailing Address - Street 2:SUTIE F.
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2260
Mailing Address - Country:US
Mailing Address - Phone:505-299-7777
Mailing Address - Fax:505-299-7777
Practice Address - Street 1:8400 MENAUL BLVD NE
Practice Address - Street 2:SUTIE F.
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2260
Practice Address - Country:US
Practice Address - Phone:505-299-7777
Practice Address - Fax:505-299-7777
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0803237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter