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General NPI Number Information
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NPI Number | 1346362316
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Entity Type | Individual
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Provider Name | SUZANNE J. GRANT N.P.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 4020 5TH AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-2106
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Country | US
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Telephone | 619-260-7022
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Fax | 619-260-7310
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Provider Business Mailing Address
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Address Line | 4317 ALDER DR
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City | SAN DIEGO
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State | CA
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Zip | 92116-2323
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Country | US
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Telephone | 619-280-5587
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Fax | 619-280-9039
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 281041
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License Number State | CA
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