Individual
LISA GRIZZLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
330 EL CERRO MISSION, LOS LUNAS, NM 87031
(361) 772-8419
Mailing address
306 S LAVACA, MOULTON, TX 77975-4854
(361) 772-8419
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
3672
NM
Other
Enumeration date
03/16/2017
Last updated
03/16/2017
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