Healthcare Provider Details

I. General information

NPI: 1285925206
Provider Name (Legal Business Name): MRS. VANESSA KATRINA GRANADOS I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W 18TH ST
MERCED CA
95340-4604
US

IV. Provider business mailing address

815 W 18TH ST
MERCED CA
95340-4604
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-2125
  • Fax: 209-726-4430
Mailing address:
  • Phone: 209-725-2125
  • Fax: 209-726-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: