Healthcare Provider Details

I. General information

NPI: 1548571623
Provider Name (Legal Business Name): DEEPA MARIA GRANDON M.D., M.B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEEPA MARIA GEORGE M.D, M.B.A

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E ELEANA LN
GILBERT AZ
85298-5776
US

IV. Provider business mailing address

1400 VILLAGE SQUARE BLVD # 3-85340
TALLAHASSEE FL
32312-1250
US

V. Phone/Fax

Practice location:
  • Phone: 602-905-5155
  • Fax: 602-654-1847
Mailing address:
  • Phone: 602-905-5155
  • Fax: 602-654-1847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46470
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA 112797
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number46470
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: