Individual
MR. SANTIEGO ANTONIO GRIJALVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 MERCY CIRCLE DR, CAMP PENDLETON, CA 92055
(760) 719-3712
Mailing address
28328 INSPIRATION LAKE DR, MENIFEE, CA 92584-8034
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
RN624388
CA
Other
Enumeration date
10/13/2021
Last updated
10/13/2021
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