Provider Demographics
NPI:1447014279
Name:DIEGO GRISALES NP IN FAMILY HEALTH PLLC
Entity type:Organization
Organization Name:DIEGO GRISALES NP IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:GRISALES
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:585-755-1705
Mailing Address - Street 1:2364 LYELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHETSER
Mailing Address - State:NY
Mailing Address - Zip Code:14606
Mailing Address - Country:US
Mailing Address - Phone:585-755-1705
Mailing Address - Fax:
Practice Address - Street 1:2364 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5738
Practice Address - Country:US
Practice Address - Phone:585-755-1705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty