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General NPI Number Information
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NPI Number | 1417839598
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Entity Type | Individual
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Provider Name | ALESIA GRANT
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Gender | Female
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 11801 PIERCE ST STE 200
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City | RIVERSIDE
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State | CA
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Zip | 92505-4400
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Country | US
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Telephone | 909-435-5136
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Fax |
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Provider Business Mailing Address
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Address Line | 14007 HEALING WAY
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City | FONTANA
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State | CA
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Zip | 92335-0401
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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 |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 113741
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License Number State | CA
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