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Individual

EDDIE RALPH GRIJALVA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1412 17TH ST, BAKERSFIELD, CA 93301-5211
(661) 293-5426
Mailing address
1412 17TH ST STE 357, BAKERSFIELD, CA 93301-5211
(661) 293-5426

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
E3407560
CA

Other

Enumeration date
09/14/2021
Last updated
09/14/2021
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Product
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  • EDI platform