Healthcare Provider Details

I. General information

NPI: 1356334858
Provider Name (Legal Business Name): JOHN W. GRANETO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N CLOVIS AVE
CLOVIS CA
93612-0303
US

IV. Provider business mailing address

120 N CLOVIS AVE
CLOVIS CA
93612-0303
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-3600
  • Fax:
Mailing address:
  • Phone: 559-325-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-075516
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: