Healthcare Provider Details

I. General information

NPI: 1467799502
Provider Name (Legal Business Name): CHRISTINA KINNEVEY GREIG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 COURAGE DR
FAIRFIELD CA
94533-6733
US

IV. Provider business mailing address

5 CAROLINA DR
BENICIA CA
94510-2518
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-2010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA138223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: