Healthcare Provider Details

I. General information

NPI: 1689396459
Provider Name (Legal Business Name): MICHAEL GRANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 STOCKDALE HWY
BAKERSFIELD CA
93309-2656
US

IV. Provider business mailing address

10308 CAVE AVE
BAKERSFIELD CA
93312-2411
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-5000
  • Fax:
Mailing address:
  • Phone: 661-477-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: