Healthcare Provider Details

I. General information

NPI: 1215260898
Provider Name (Legal Business Name): MR. DARREN ANTHONY GRIEGO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CR 103, MANZANA CENTER, BUILDING 3
CHIMAYO NM
87522
US

IV. Provider business mailing address

PO BOX 301
DIXON NM
87527-0301
US

V. Phone/Fax

Practice location:
  • Phone: 505-351-1456
  • Fax: 505-351-1556
Mailing address:
  • Phone: 505-351-1456
  • Fax: 505-351-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: