Provider Demographics
NPI:1053620252
Name:VALLES-DE LA CRUZ, GRISELDA (BS)
Entity type:Individual
Prefix:MRS
First Name:GRISELDA
Middle Name:
Last Name:VALLES-DE LA CRUZ
Suffix:
Gender:
Credentials:BS
Other - Prefix:
Other - First Name:GRISELDA
Other - Middle Name:
Other - Last Name:VALLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:679 S NEW HAMPSHIRE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1355
Mailing Address - Country:US
Mailing Address - Phone:213-639-2500
Mailing Address - Fax:
Practice Address - Street 1:679 S NEW HAMPSHIRE AVE STE 400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1355
Practice Address - Country:US
Practice Address - Phone:213-639-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner