Active NPI
Maynor Antonio Grijalva, MS, LAT, ATC
- Athletic Trainer
- Lynn, MA
National Provider Identifier
1659038495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 3877
- Practice address
- 1000 Western Ave
Lynn, MA 01905-2655 - Phone
- (978) 880-5178
- NPI assigned
- Nov 28, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 3877 | MA | Primary |
Addresses
Primary practice location
1000 Western Ave
Lynn, MA 01905-2655
Mailing address
452 Western Ave
Lynn, MA 01904-3315
Phone (617) 650-4854
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3877 | MA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1638057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1712188800000",
"number": "1659038495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "452 WESTERN AVE",
"city": "LYNN",
"state": "MA",
"postal_code": "019043315",
"telephone_number": "617-650-4854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 WESTERN AVE",
"city": "LYNN",
"state": "MA",
"postal_code": "019052655",
"telephone_number": "978-880-5178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIJALVA",
"first_name": "MAYNOR",
"middle_name": "ANTONIO",
"name_prefix": "Mr.",
"credential": "MS, LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-11-28",
"last_updated": "2024-04-04",
"certification_date": "2024-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "3877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.