Provider Demographics
NPI:1154035525
Name:GRIGGS, ARCANDIDA RENEA
Entity type:Individual
Prefix:
First Name:ARCANDIDA
Middle Name:RENEA
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 JAN ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8721
Mailing Address - Country:US
Mailing Address - Phone:832-598-8405
Mailing Address - Fax:
Practice Address - Street 1:3935 JAN ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8721
Practice Address - Country:US
Practice Address - Phone:832-598-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty