Healthcare Provider Details

I. General information

NPI: 1174292759
Provider Name (Legal Business Name): GRANT ALEXANDER HOLLANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30428 HAUN RD STE 810
MENIFEE CA
92584-6824
US

IV. Provider business mailing address

30428 HAUN RD STE 810
MENIFEE CA
92584-6824
US

V. Phone/Fax

Practice location:
  • Phone: 951-696-9353
  • Fax:
Mailing address:
  • Phone: 951-696-9353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number37756
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: