Individual
MAKAYLA GRIMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11776 MARIPOSA RD # 103, HESPERIA, CA 92345-1622
(760) 956-2462
Mailing address
7428 NIELSON RD, PHELAN, CA 92371-6854
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
40565
CA
Other
Enumeration date
01/11/2022
Last updated
01/27/2022
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