Provider Demographics
NPI:1407035298
Name:ENRIQUE GRIEGO M.D.P.A.
Entity Type:Organization
Organization Name:ENRIQUE GRIEGO M.D.P.A.
Other - Org Name:GUAJIRA FAMILY CLINIC & DIABETES CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-631-4496
Mailing Address - Street 1:1900 S JACKSON RD STE 9
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1589
Mailing Address - Country:US
Mailing Address - Phone:956-687-6667
Mailing Address - Fax:956-618-1075
Practice Address - Street 1:1900 S JACKSON RD STE 9
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1589
Practice Address - Country:US
Practice Address - Phone:956-687-6667
Practice Address - Fax:956-618-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA3510OtherMEDICARE PTAN