Individual
MARY L. GREBENC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 UNM, ALBUQUERQUE, NM 87131-3616
(505) 272-2525
(505) 272-6055
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
90-199
NM
2085R0202X
Diagnostic Radiology Physician
G87233
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G872330
BLUE SHIELD PIN
CA
05
—
00G872330
—
CA
Enumeration date
05/17/2006
Last updated
03/10/2025
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