Provider Demographics
NPI:1144210428
Name:GRIEGO, JANET E (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:E
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 1:1100 CENTRAL AVE SE
Mailing Address - Street 2:LABORATORY
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4930
Mailing Address - Country:US
Mailing Address - Phone:505-841-1995
Mailing Address - Fax:505-841-1373
Practice Address - Street 1:1100 CENTRAL AVE SE
Practice Address - Street 2:LABORATORY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4930
Practice Address - Country:US
Practice Address - Phone:505-841-1995
Practice Address - Fax:505-841-1373
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-65207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM301109Medicare PIN
NMNM301108Medicare PIN