Provider Demographics
NPI:1558159244
Name:GRIEGO, JONATHAN BELTRAN (CPSW)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BELTRAN
Last Name:GRIEGO
Suffix:
Gender:
Credentials:CPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1644
Mailing Address - Country:US
Mailing Address - Phone:866-425-1912
Mailing Address - Fax:
Practice Address - Street 1:3655 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1644
Practice Address - Country:US
Practice Address - Phone:866-425-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator