Provider Demographics
NPI:1003107608
Name:MARSHA GRANESE, MD, INC.
Entity Type:Organization
Organization Name:MARSHA GRANESE, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:FUNDERBURK
Authorized Official - Last Name:GRANESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-589-6487
Mailing Address - Street 1:22032 EL PASEO
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3947
Mailing Address - Country:US
Mailing Address - Phone:949-589-6487
Mailing Address - Fax:
Practice Address - Street 1:22032 EL PASEO
Practice Address - Street 2:SUITE 200
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3947
Practice Address - Country:US
Practice Address - Phone:949-589-6487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty