Healthcare Provider Details

I. General information

NPI: 1497422000
Provider Name (Legal Business Name): NAOMI S GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 ATLANTIC AVE STE 230
LONG BEACH CA
90806-1735
US

IV. Provider business mailing address

2880 ATLANTIC AVE STE 230
LONG BEACH CA
90806-1735
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-4404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number130206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: