Provider Demographics
NPI:1841029998
Name:GRIJALVA, HECTOR R
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:R
Last Name:GRIJALVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12455
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87195-0455
Mailing Address - Country:US
Mailing Address - Phone:505-312-7296
Mailing Address - Fax:
Practice Address - Street 1:1317 ISLETA BLVD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-4035
Practice Address - Country:US
Practice Address - Phone:505-312-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker