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General NPI Number Information
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NPI Number | 1417066432
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Entity Type | Organization
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Legal Business Name | MARIA SEMBRANO GRANTHOM, M.D. INC.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 12/10/2007
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Provider Practice Location Address
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Address Line | 208 GREEN VALLEY RD
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City | FREEDOM
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State | CA
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Zip | 95019-3135
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Country | US
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Telephone | 831-728-1489
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Fax | 831-728-0936
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Provider Business Mailing Address
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Address Line | 208 GREEN VALLEY RD
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City | FREEDOM
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State | CA
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Zip | 95019-3135
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Country | US
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Telephone | 831-728-1489
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Fax | 831-728-0936
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA SEMBRANO GRANTHOM
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Credential | M.D.
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Telephone | 831-728-1489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A33532
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License Number State | CA
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