Provider Demographics
NPI:1578674727
Name:GRENCH, CAROL S (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:GRENCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2030 SUTTER PL
Practice Address - Street 2:#2000
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6201
Practice Address - Country:US
Practice Address - Phone:530-750-5800
Practice Address - Fax:530-750-5804
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG85092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G850920Medicaid
A08015Medicare UPIN
CA00G850922Medicare PIN
00G850920Medicare ID - Type Unspecified