Healthcare Provider Details

I. General information

NPI: 1265380703
Provider Name (Legal Business Name): JUDITH GRANADOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47950 DUNE PALMS RD
LA QUINTA CA
92253-4000
US

IV. Provider business mailing address

99293 VIA COSTA BRAVA
MECCA CA
92254-3106
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21314
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: