Provider Demographics
NPI:1831515964
Name:GRIJALVA, MARIA (AUD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13121 CLEARWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1815
Mailing Address - Country:US
Mailing Address - Phone:661-426-5800
Mailing Address - Fax:562-219-5421
Practice Address - Street 1:5100 CALIFORNIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0707
Practice Address - Country:US
Practice Address - Phone:661-426-5800
Practice Address - Fax:562-219-5421
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7836237700000X
CAAU2967237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF400319562OtherMEDICARE