Healthcare Provider Details

I. General information

NPI: 1760688519
Provider Name (Legal Business Name): IRENE GRIAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11511 CANTERWOOD BLVD NW STE 145
GIG HARBOR WA
98332-5813
US

IV. Provider business mailing address

11511 CANTERWOOD BLVD NW STE 145
GIG HARBOR WA
98332-5813
US

V. Phone/Fax

Practice location:
  • Phone: 253-530-2940
  • Fax: 253-530-2970
Mailing address:
  • Phone: 253-530-2940
  • Fax: 253-530-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberOP60460467
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: