Individual
EDWARD GRIJALVA SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2601 N CAMPBELL AVE STE 108, TUCSON, AZ 85719-3164
(520) 623-6015
(520) 623-4590
Mailing address
2601 N CAMPBELL AVE STE 108, TUCSON, AZ 85719-3164
(520) 623-6015
(520) 623-4590
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11811
AZ
Other
Enumeration date
02/16/2016
Last updated
02/16/2016
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