Individual
CLARISSE GRIJALVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2884 N ROADRUNNER PKWY, LAS CRUCES, NM 88011-0853
(575) 519-2934
Mailing address
4114 SANTIAGO WAY, LAS CRUCES, NM 88011-7283
(575) 519-2934
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3571
NM
Other
Enumeration date
06/25/2018
Last updated
06/25/2018
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