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NPI Code Detail

MEDICARE: ELIZABETH GRIGSBY

MEDICARE: ELIZABETH GRIGSBY
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
12279C0205XCritical Care Registered Respiratory Therapist28887CA
22278C0205XCritical Care Certified Respiratory Therapist

General Provider Information

NPI Number : 1700358082
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH GRIGSBY
Provider Business Mailing Address
First Line : 9908 TIVOLI DR
Second Line :
City : STOCKTON
State : CA
Zip : 95212-3116
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1600 EUREKA RD
Second Line :
City : ROSEVILLE
State : CA
Zip : 95661-3027
Country : US
Telephone Number : 916-474-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2018
Last Update Date : 12/26/2018

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