1558372292 NPI number — MS. DEANNA CAROLE GRENIER-MULLINS N.P.

Table of content: MS. DEANNA CAROLE GRENIER-MULLINS N.P. (NPI 1558372292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558372292 NPI number — MS. DEANNA CAROLE GRENIER-MULLINS N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRENIER-MULLINS
Provider First Name:
DEANNA
Provider Middle Name:
CAROLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAPLES
Provider Other First Name:
DEANNA
Provider Other Middle Name:
CAROLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558372292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5855 SILVER CREEK VALLEY RD # 171-3N5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95138-1059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-574-9173
Provider Business Mailing Address Fax Number:
650-858-8905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 MIRANDA AVE
Provider Second Line Business Practice Location Address:
HBPC-SAN JOSE CLINIC
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-363-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  RN 502181, NPF 7829 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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