Provider Demographics
NPI:1831217751
Name:GRIJALVA, BRENDA (DC)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:GRIJALVA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR
Mailing Address - Street 2:STE.#B114
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1714
Mailing Address - Country:US
Mailing Address - Phone:858-453-6550
Mailing Address - Fax:858-453-5782
Practice Address - Street 1:8950 VILLA LA JOLLA DR
Practice Address - Street 2:STE.#B114
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1714
Practice Address - Country:US
Practice Address - Phone:858-453-6550
Practice Address - Fax:858-453-5782
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor