Provider Demographics
NPI:1417748674
Name:GRILLONE, SOPHIE VICTORIA
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:VICTORIA
Last Name:GRILLONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 W BUTLER DR APT 205
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4217
Mailing Address - Country:US
Mailing Address - Phone:208-339-7733
Mailing Address - Fax:
Practice Address - Street 1:2037 W BUTLER DR APT 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4217
Practice Address - Country:US
Practice Address - Phone:208-339-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty