Healthcare Provider Details

I. General information

NPI: 1053791509
Provider Name (Legal Business Name): GRANDY PODIATRY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2015
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 46TH ST
SACRAMENTO CA
95819-3149
US

IV. Provider business mailing address

PO BOX 191513
SACRAMENTO CA
95819-7513
US

V. Phone/Fax

Practice location:
  • Phone: 916-548-7837
  • Fax: 209-473-1405
Mailing address:
  • Phone: 916-548-7837
  • Fax: 209-473-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE3293
License Number StateCA

VIII. Authorized Official

Name: DR. DENNIS W GRANDY
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 916-548-7837