Healthcare Provider Details

I. General information

NPI: 1497253371
Provider Name (Legal Business Name): JAYMES D. GRANATA, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W WASHINGTON AVE STE 460
LAS VEGAS NV
89128-4338
US

IV. Provider business mailing address

7455 W WASHINGTON AVE STE 460
LAS VEGAS NV
89128-4338
US

V. Phone/Fax

Practice location:
  • Phone: 702-765-0884
  • Fax: 702-765-0862
Mailing address:
  • Phone: 702-765-0884
  • Fax: 702-765-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAYMES GRANATA
Title or Position: OWNER
Credential: MD
Phone: 702-944-0375