Healthcare Provider Details

I. General information

NPI: 1013842921
Provider Name (Legal Business Name): CHRISTOPHER GRANADOS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12171 WORLD TRADE DR
SAN DIEGO CA
92128-3709
US

IV. Provider business mailing address

969 MARKET ST UNIT 505
SAN DIEGO CA
92101-7285
US

V. Phone/Fax

Practice location:
  • Phone: 858-290-0855
  • Fax:
Mailing address:
  • Phone: 951-691-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: