Healthcare Provider Details

I. General information

NPI: 1003740333
Provider Name (Legal Business Name): LAURA ELIZABETH GRANILLO GILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELIZABETH GRANILLO

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65750 AVENIDA JALISCO
DESERT HOT SPRINGS CA
92240-1674
US

IV. Provider business mailing address

68649 CALLE PRADO
CATHEDRAL CITY CA
92234-4857
US

V. Phone/Fax

Practice location:
  • Phone: 760-251-7244
  • Fax:
Mailing address:
  • Phone: 760-902-0483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number35821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: