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NPI Code Detail

MEDICARE: DR. ANGELA MARIE GRANATA D.P.M.

MEDICARE: DR. ANGELA MARIE GRANATA D.P.M.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery Podiatrist2007NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669739827
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELA MARIE GRANATA D.P.M.
Provider Business Mailing Address
First Line : 7455 W WASHINGTON AVE STE 460
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-4338
Country : US
Telephone Number : 702-765-0884
Fax Number : 702-765-0862
Provider Business Practice Location Address
First Line : 10105 BANBURRY CROSS DR STE 445
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-6645
Country : US
Telephone Number : 702-765-0884
Fax Number : 702-765-0862
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2012
Last Update Date : 03/17/2021

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