Provider Demographics
NPI:1801933684
Name:JAMES SANTIAGO GRISOLIA, M.D. INC
Entity type:Organization
Organization Name:JAMES SANTIAGO GRISOLIA, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SANTIAGO
Authorized Official - Last Name:GRISOLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-297-1155
Mailing Address - Street 1:4033 3RD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2130
Mailing Address - Country:US
Mailing Address - Phone:619-297-1155
Mailing Address - Fax:
Practice Address - Street 1:4033 3RD AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2130
Practice Address - Country:US
Practice Address - Phone:619-297-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG428842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G428840Medicaid
CA00G428840Medicaid
CA00G428840Medicaid