Provider Demographics
NPI:1922807874
Name:GARCIA GRISALES, LINA FERNANDA (SA-C)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:FERNANDA
Last Name:GARCIA GRISALES
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 N HAMLIN AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7212
Mailing Address - Country:US
Mailing Address - Phone:872-325-9982
Mailing Address - Fax:
Practice Address - Street 1:2930 N HAMLIN AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7212
Practice Address - Country:US
Practice Address - Phone:872-325-9982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL25-197246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant