Provider Demographics
NPI:1275799371
Name:GREY RIVERIA, PAULETTE LUCILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:LUCILLE
Last Name:GREY RIVERIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAULETTE
Other - Middle Name:LUCILLE
Other - Last Name:GREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9655 PERKINS RD STE C260
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-1533
Mailing Address - Country:US
Mailing Address - Phone:225-449-9606
Mailing Address - Fax:225-217-3437
Practice Address - Street 1:618 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70801-1910
Practice Address - Country:US
Practice Address - Phone:225-449-9606
Practice Address - Fax:225-217-3437
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72675207Q00000X
DCMD040755207Q00000X
LA322792207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine