Healthcare Provider Details

I. General information

NPI: 1346362316
Provider Name (Legal Business Name): SUZANNE J. GRANT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 5TH AVE
SAN DIEGO CA
92103-2106
US

IV. Provider business mailing address

4317 ALDER DR
SAN DIEGO CA
92116-2323
US

V. Phone/Fax

Practice location:
  • Phone: 619-260-7022
  • Fax: 619-260-7310
Mailing address:
  • Phone: 619-280-5587
  • Fax: 619-280-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number281041
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: