Individual
MR. MAYNOR ANTONIO GRIJALVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
1000 WESTERN AVE, LYNN, MA 01905-2655
(978) 880-5178
Mailing address
452 WESTERN AVE, LYNN, MA 01904-3315
(617) 650-4854
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
3877
MA
Other
Enumeration date
11/28/2021
Last updated
04/04/2024
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