Provider Demographics
NPI:1972080075
Name:GRINDATTO, JEAN-MARC DANIEL
Entity Type:Individual
Prefix:
First Name:JEAN-MARC
Middle Name:DANIEL
Last Name:GRINDATTO
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 1:1248 W ELLA DR
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-7236
Mailing Address - Country:US
Mailing Address - Phone:505-715-1525
Mailing Address - Fax:
Practice Address - Street 1:4505 DONA MARGUERITA AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2441
Practice Address - Country:US
Practice Address - Phone:505-715-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker