MEDICARE: CAROLINE GRIECO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner	IMF46205	CA

General Provider Information

NPI Number	:	1154454049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE GRIECO

Provider Business Mailing Address
First Line	:	5411 BONANZA DR
Second Line	:
City	:	HUNINGTON BEACH
State	:	CA
Zip	:	92649
Country	:	US
Telephone Number	:	714-377-9479
Fax Number	:

Provider Business Practice Location Address
First Line	:	2931 REDONDO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806
Country	:	US
Telephone Number	:	562-490-7600
Fax Number	:	562-490-7601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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Directions to “ CAROLINE GRIECO ” Practice Location

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