Healthcare Provider Details

I. General information

NPI: 1346653144
Provider Name (Legal Business Name): FRANK GRANADOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 RAMONA BLVD STE. I
IRWINDALE CA
91706-3752
US

IV. Provider business mailing address

2131 W SAN BERNARDINO RD SPC #50
WEST COVINA CA
91790-1046
US

V. Phone/Fax

Practice location:
  • Phone: 626-337-3828
  • Fax:
Mailing address:
  • Phone: 626-327-5232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: