Healthcare Provider Details

I. General information

NPI: 1386347581
Provider Name (Legal Business Name): DR. MARTIN LARRY GRANADOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 CALIFORNIA AVE STE 400B
BAKERSFIELD CA
93309-7081
US

IV. Provider business mailing address

4900 CALIFORNIA AVE STE 400B
BAKERSFIELD CA
93309-7081
US

V. Phone/Fax

Practice location:
  • Phone: 661-459-1900
  • Fax:
Mailing address:
  • Phone: 661-459-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA20A25118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: