Healthcare Provider Details

I. General information

NPI: 1497345904
Provider Name (Legal Business Name): MICHAEL T GRAMMAS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20072 SW BIRCH ST STE 190
NEWPORT BEACH CA
92660-0799
US

IV. Provider business mailing address

27762 ANTONIO PKWY L1 #325
LADERA RANCH CA
92694
US

V. Phone/Fax

Practice location:
  • Phone: 949-235-7735
  • Fax:
Mailing address:
  • Phone: 949-235-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number152871
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number152871
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: