Healthcare Provider Details

I. General information

NPI: 1285833871
Provider Name (Legal Business Name): EVA GABRIELE GRANZOW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 29TH ST STE 480
SACRAMENTO CA
95816
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-887-0780
  • Fax: 916-887-0786
Mailing address:
  • Phone: 866-681-0736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA94605
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA94605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: