Provider Demographics
NPI:1780974527
Name:GRIEGO, ANN-ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ANN-ELIZABETH
Middle Name:
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 1:652 PETALUMA AVE STE H
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4266
Mailing Address - Country:US
Mailing Address - Phone:707-823-3166
Mailing Address - Fax:707-869-8170
Practice Address - Street 1:652 PETALUMA AVE STE H
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4266
Practice Address - Country:US
Practice Address - Phone:707-823-3166
Practice Address - Fax:707-869-8170
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN