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General NPI Number Information
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NPI Number | 1174462584
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Entity Type | Organization
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Legal Business Name | GRIYO PRIMARY CARE LLC
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Dates
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Enumeration Date | 03/28/2026
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Last Update Date | 03/28/2026
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Provider Practice Location Address
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Address Line | 8223 FREDERICKSBURG RD
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3355
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Country | US
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Telephone | 214-983-8511
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Fax | 346-980-1471
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Provider Business Mailing Address
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Address Line | 8223 FREDERICKSBURG RD
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3355
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Country | US
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Telephone | 214-983-8511
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Fax | 346-980-1471
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | LISE VALERIE AGNANT MALEBRANCHE
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Credential | MD
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Telephone | 214-983-8511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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