Individual
MR. MATTHEW LORAN GRILE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1325 PACIFIC HWY UNIT 3501, SAN DIEGO, CA 92101-2600
(858) 945-6410
Mailing address
3538 DEL REY ST APT 9, SAN DIEGO, CA 92109-5722
(321) 604-5233
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G640-552-79-308-0
DRIVER LICENSE
FL
Enumeration date
10/21/2019
Last updated
10/21/2019
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