Provider Demographics
NPI:1316483431
Name:GRILLO, JESSICA MARIA (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIA
Last Name:GRILLO
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 W EL CAMINO REAL APT 3403
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6238
Mailing Address - Country:US
Mailing Address - Phone:203-710-4658
Mailing Address - Fax:
Practice Address - Street 1:2280 W EL CAMINO REAL APT 3403
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-6238
Practice Address - Country:US
Practice Address - Phone:203-710-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013785363LA2100X
CT6905363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care