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General NPI Number Information
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NPI Number | 1407710916
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Entity Type | Organization
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Legal Business Name | SHANNON L GRANGER D. O. INC
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 12264 EL CAMINO REAL
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City | SAN DIEGO
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State | CA
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Zip | 92130-3058
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Country | US
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Telephone | 858-755-3937
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34120
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City | RENO
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State | NV
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Zip | 89533-4120
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Country | US
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Telephone | 775-747-5050
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Fax | 775-747-5005
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON L GRANGER
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Credential | DO
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Telephone | 858-755-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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