Individual
PHILLIP JEROME GRIEGO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
460 SAINT MICHAELS DR STE 1104, SANTA FE, NM 87505-7709
(505) 820-2562
Mailing address
PO BOX 384, DIXON, NM 87527-0384
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2025-0119
NM
Other
Enumeration date
11/11/2025
Last updated
12/02/2025
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