Provider Demographics
NPI:1972356681
Name:GRIGUS, PAIGE ALEXANDRA
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ALEXANDRA
Last Name:GRIGUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4521 CAMPUS DR STE 386
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2621
Mailing Address - Country:US
Mailing Address - Phone:949-382-1652
Mailing Address - Fax:818-617-2957
Practice Address - Street 1:43 CORPORATE PARK STE 205
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5180
Practice Address - Country:US
Practice Address - Phone:949-382-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty