Healthcare Provider Details

I. General information

NPI: 1184825416
Provider Name (Legal Business Name): ANTONIO GRANADOS ALVAREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 BATH ST STE 113
SANTA BARBARA CA
93105-4339
US

IV. Provider business mailing address

2320 BATH ST STE 113
SANTA BARBARA CA
93105-4339
US

V. Phone/Fax

Practice location:
  • Phone: 650-515-5072
  • Fax:
Mailing address:
  • Phone: 650-515-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA115592
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA4346982
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD12793
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA115592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: