Provider Demographics
NPI:1669605614
Name:JIMENEZ-GRILLO, JEANETTE (NP)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:JIMENEZ-GRILLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:JIMENEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1288 CAMINO DEL RIO N
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1511
Mailing Address - Country:US
Mailing Address - Phone:619-542-0025
Mailing Address - Fax:
Practice Address - Street 1:1288 CAMINO DEL RIO N
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1511
Practice Address - Country:US
Practice Address - Phone:619-542-0025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA842062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily