Healthcare Provider Details

I. General information

NPI: 1376262907
Provider Name (Legal Business Name): PAULA DANELLE GRIECO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 SHAW AVE
CLOVIS CA
93612-3961
US

IV. Provider business mailing address

1758 N BUNDY AVE
CLOVIS CA
93619-8151
US

V. Phone/Fax

Practice location:
  • Phone: 559-321-0886
  • Fax: 559-547-3194
Mailing address:
  • Phone: 559-283-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: