Healthcare Provider Details

I. General information

NPI: 1003730730
Provider Name (Legal Business Name): NANCY GRANADOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 HOWE AVE
SACRAMENTO CA
95825-3912
US

IV. Provider business mailing address

8875 LEWIS STEIN RD APT 166
ELK GROVE CA
95758-8436
US

V. Phone/Fax

Practice location:
  • Phone: 844-664-2248
  • Fax:
Mailing address:
  • Phone: 209-642-1702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN747590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: