MEDICARE: MARIA SEMBRANO GRANTHOM, M.D. INC.

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	207V00000X	Obstetrics & Gynecology Physician	A33532	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417066432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIA SEMBRANO GRANTHOM, M.D. INC.

Provider Business Mailing Address
First Line	:	208 GREEN VALLEY RD
Second Line	:
City	:	FREEDOM
State	:	CA
Zip	:	95019-3135
Country	:	US
Telephone Number	:	831-728-1489
Fax Number	:	831-728-0936

Provider Business Practice Location Address
First Line	:	208 GREEN VALLEY RD
Second Line	:
City	:	FREEDOM
State	:	CA
Zip	:	95019-3135
Country	:	US
Telephone Number	:	831-728-1489
Fax Number	:	831-728-0936

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIA SEMBRANO GRANTHOM
Credential	:	M.D.
Telephone Number	:	831-728-1489

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/10/2007

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