Healthcare Provider Details

I. General information

NPI: 1861313462
Provider Name (Legal Business Name): GABRIELA GRANADOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16082 AVENUE 328
IVANHOE CA
93235-1602
US

IV. Provider business mailing address

16082 AVENUE 328
IVANHOE CA
93235-1602
US

V. Phone/Fax

Practice location:
  • Phone: 559-577-5738
  • Fax:
Mailing address:
  • Phone: 559-577-5738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: