Provider Demographics
NPI:1891907812
Name:GRIJALVA, KAREN JEAN (PHD, MHRS)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:JEAN
Last Name:GRIJALVA
Suffix:
Gender:
Credentials:PHD, MHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 PAUL MINNIE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1742
Mailing Address - Country:US
Mailing Address - Phone:831-566-7027
Mailing Address - Fax:
Practice Address - Street 1:321 E BEACH ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4801
Practice Address - Country:US
Practice Address - Phone:831-600-5303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2012679103T00000X
CA171M00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator