Provider Demographics
NPI:1811629694
Name:GRIEGO, CAROLE BRESNAHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:BRESNAHAN
Last Name:GRIEGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6134 E INDIAN BEND RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3440
Mailing Address - Country:US
Mailing Address - Phone:480-244-9159
Mailing Address - Fax:
Practice Address - Street 1:6134 E INDIAN BEND RD
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-3440
Practice Address - Country:US
Practice Address - Phone:480-244-9159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24115208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics