Healthcare Provider Details

I. General information

NPI: 1093706244
Provider Name (Legal Business Name): ANDERS E GRANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FLORIDA AVE STE 102
MODESTO CA
95350-4446
US

IV. Provider business mailing address

1400 FLORIDA AVE STE 102 102
MODESTO CA
95350-4446
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-4842
  • Fax:
Mailing address:
  • Phone: 443-842-6788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD02163
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number18596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: