=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386909265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. REGINA GRANADOS, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2012
-----------------------------------------------------
Last Update Date | 07/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1899 E ROSEVILLE PKWY STE 140 STE # 140
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-7980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-938-3088
-----------------------------------------------------
Fax | 916-358-8488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1899 E ROSEVILLE PKWY STE 140 STE # 140
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-7980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-938-3088
-----------------------------------------------------
Fax | 916-358-8488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRINCIPAL RESEARCH INVESTIAGATOR
-----------------------------------------------------
Name | DR. R. MARIE-ADEL DE ONATE -GRANADOS
-----------------------------------------------------
Credential | RESEARCHER - PSYD
-----------------------------------------------------
Telephone | 916-932-3088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1744R1102X
-----------------------------------------------------
Taxonomy Name | Research Study Specialist
-----------------------------------------------------
License Number | 21246
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------