Healthcare Provider Details

I. General information

NPI: 1417066432
Provider Name (Legal Business Name): MARIA SEMBRANO GRANTHOM, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 GREEN VALLEY RD
FREEDOM CA
95019-3135
US

IV. Provider business mailing address

208 GREEN VALLEY RD
FREEDOM CA
95019-3135
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-1489
  • Fax: 831-728-0936
Mailing address:
  • Phone: 831-728-1489
  • Fax: 831-728-0936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA33532
License Number StateCA

VIII. Authorized Official

Name: DR. MARIA SEMBRANO GRANTHOM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 831-728-1489