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General NPI Number Information
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NPI Number | 1588603542
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Entity Type | Individual
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Provider Name | CHRISTIAN L GRANDELL PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 2035 MESQUITE AVE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5894
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Country | US
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Telephone | 928-208-4598
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Fax | 888-571-6436
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Provider Business Mailing Address
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Address Line | 2035 MESQUITE AVE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5894
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Country | US
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Telephone | 928-208-4598
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Fax | 888-571-6436
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2719
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License Number State | AZ
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