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General NPI Number Information
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NPI Number | 1366852980
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Entity Type | Organization
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Legal Business Name | J R GRANDHE MD MEDICAL CORP
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 05/05/2014
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Provider Practice Location Address
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Address Line | 6401 TRUXTUN AVE STE B
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City | BAKERSFIELD
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State | CA
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Zip | 93309-0674
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Country | US
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Telephone | 661-327-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 6401 TRUXTUN AVE STE B
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City | BAKERSFIELD
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State | CA
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Zip | 93309-0674
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | J. R. GRANDHE
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Credential |
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Telephone | 661-327-9300
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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 | 95000364
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License Number State | CA
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