1386909265 NPI number — DR. REGINA GRANADOS, INCORPORATED

Table of content: (NPI 1386909265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386909265 NPI number — DR. REGINA GRANADOS, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. REGINA GRANADOS, INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386909265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1899 E ROSEVILLE PKWY STE 140
Provider Second Line Business Mailing Address:
STE # 140
Provider Business Mailing Address City Name:
ROSEVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95661-7980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-938-3088
Provider Business Mailing Address Fax Number:
916-358-8488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1899 E ROSEVILLE PKWY STE 140
Provider Second Line Business Practice Location Address:
STE # 140
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95661-7980
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-938-3088
Provider Business Practice Location Address Fax Number:
916-358-8488
Provider Enumeration Date:
07/07/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DE ONATE -GRANADOS
Authorized Official First Name:
R. MARIE-ADEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRINCIPAL RESEARCH INVESTIAGATOR
Authorized Official Telephone Number:
916-932-3088

Provider Taxonomy Codes

  • Taxonomy code: 1744R1102X , with the licence number:  21246 , 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)

  • Identifier: PSY21246 . This is a "CA DEPARTMENT OF CONSUMER AFFAIRS LICENSING DIVISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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