1730252743 NPI number — MRS. KATHERINE GRIJALVA MA EDUCATION GRADUAT

Table of content: MRS. KATHERINE GRIJALVA MA EDUCATION GRADUAT (NPI 1730252743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730252743 NPI number — MRS. KATHERINE GRIJALVA MA EDUCATION GRADUAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIJALVA
Provider First Name:
KATHERINE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA EDUCATION GRADUAT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730252743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 BEAVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARRINGTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02806-1602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-246-0085
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 WAMPANOAG TRAIL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02915-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-431-9870
Provider Business Practice Location Address Fax Number:
401-438-1957
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFT00130 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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