Individual
JESSE GRULLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1031 W 34TH ST STE 450, LOS ANGELES, CA 90089-2070
(213) 740-0215
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(213) 740-0215
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
PT298714
CA
Other
Enumeration date
07/07/2020
Last updated
03/22/2021
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