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General NPI Number Information
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NPI Number | 1235249012
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Entity Type | Individual
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Provider Name | JOHN GRANT
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Gender | Male
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 704 LEBEC ROAD
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City | LEBEC
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State | CA
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Zip | 93243
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Country | US
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Telephone | 661-248-5250
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Fax | 661-248-5279
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Provider Business Mailing Address
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Address Line | 1430 TRUXTUN AVENUE STE 400 ATTENTION ANN LE CLINICA SIERRA VISTA PO BOX 1559
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City | BAKERSFIELD
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State | CA
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Zip | 93302-1559
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Country | US
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Telephone | 661-635-3050
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Fax | 661-869-1503
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A63101
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License Number State | CA
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