Provider Demographics
NPI:1932690419
Name:GRIJALVA, JOSE ARNULFO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ARNULFO
Last Name:GRIJALVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1106 CLAYTON LN STE 240W
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2478
Mailing Address - Country:US
Mailing Address - Phone:737-471-5402
Mailing Address - Fax:559-443-2681
Practice Address - Street 1:1106 CLAYTON LN STE 240W
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2478
Practice Address - Country:US
Practice Address - Phone:737-471-5402
Practice Address - Fax:559-443-2681
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1784502084P0800X
TXU03512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry