MEDICARE: CAROLINA GRANADOS HOMAN PA-C

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
1	363A00000X	Physician Assistant	PA61919	CA
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1407576275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA GRANADOS HOMAN PA-C

Provider Business Mailing Address
First Line	:	969 S SANTA FE AVE STE A
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-6910
Country	:	US
Telephone Number	:	760-941-7050
Fax Number	:	760-941-7142

Provider Business Practice Location Address
First Line	:	969 S SANTA FE AVE STE A
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92083-6910
Country	:	US
Telephone Number	:	760-941-7050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	02/25/2026

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Directions to “ CAROLINA GRANADOS HOMAN PA-C” Practice Location

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