1235249012 NPI number — JOHN GRANT

Table of content: JOHN GRANT (NPI 1235249012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235249012 NPI number — JOHN GRANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARCIA
Provider Other First Name:
JOHN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235249012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 TRUXTUN AVENUE STE 400
Provider Second Line Business Mailing Address:
ATTENTION ANN LE CLINICA SIERRA VISTA PO BOX 1559
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93302-1559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-635-3050
Provider Business Mailing Address Fax Number:
661-869-1503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 LEBEC ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBEC
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-248-5250
Provider Business Practice Location Address Fax Number:
661-248-5279
Provider Enumeration Date:
08/30/2006

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: 207Q00000X , with the licence number:  A63101 , 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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