Provider Demographics
NPI:1083424212
Name:GRULLON, MARILUZ (MS)
Entity type:Individual
Prefix:
First Name:MARILUZ
Middle Name:
Last Name:GRULLON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MARILUZ
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8410 W THOMAS RD STE 116
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-3356
Mailing Address - Country:US
Mailing Address - Phone:602-258-6797
Mailing Address - Fax:602-248-8113
Practice Address - Street 1:8410 W THOMAS RD STE 116
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3356
Practice Address - Country:US
Practice Address - Phone:602-258-6797
Practice Address - Fax:602-248-8113
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22697101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health