Provider Demographics
NPI:1255459020
Name:JAMES L GRISEZ, MD
Entity type:Organization
Organization Name:JAMES L GRISEZ, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MADELINE
Authorized Official - Last Name:GRISEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-489-1409
Mailing Address - Street 1:200 STATION WAY
Mailing Address - Street 2:STE 200B
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3348
Mailing Address - Country:US
Mailing Address - Phone:805-489-1409
Mailing Address - Fax:895-489-1290
Practice Address - Street 1:200 STATION WAY
Practice Address - Street 2:STE 200B
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3348
Practice Address - Country:US
Practice Address - Phone:805-489-1409
Practice Address - Fax:895-489-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical