Provider Demographics
NPI:1013276484
Name:GRIJALVA, VERONICA JAZMIN (MD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:JAZMIN
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 W SUNSET BLVD
Mailing Address - Street 2:FIFTH FLOOR
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5814
Mailing Address - Country:US
Mailing Address - Phone:323-783-1430
Mailing Address - Fax:
Practice Address - Street 1:4900 W SUNSET BLVD
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5814
Practice Address - Country:US
Practice Address - Phone:323-783-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125767207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology