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NPI Code Detail

MEDICARE: DEMETRIUS UNDRIAUS GRANVLE

MEDICARE: DEMETRIUS UNDRIAUS GRANVLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1184412868
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEMETRIUS UNDRIAUS GRANVLE
Provider Business Mailing Address
First Line : 23521 PASEO DE VALENCIA STE B5
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-3125
Country : US
Telephone Number : 949-540-0170
Fax Number : 949-540-0173
Provider Business Practice Location Address
First Line : 24953 PASEO DE VALENCIA BLDG B SUITE 1B
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-4340
Country : US
Telephone Number : 949-540-0170
Fax Number : 949-540-0173
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2025
Last Update Date : 06/15/2026

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Directions to “ DEMETRIUS UNDRIAUS GRANVLE ” Practice Location

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