Provider Demographics
NPI:1225651797
Name:GRANADOS, MAGDALENA (SUDRC#10744)
Entity Type:Individual
Prefix:MRS
First Name:MAGDALENA
Middle Name:
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:SUDRC#10744
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W KEARNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-2702
Mailing Address - Country:US
Mailing Address - Phone:559-485-0501
Mailing Address - Fax:559-485-1313
Practice Address - Street 1:1414 W KEARNEY BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2702
Practice Address - Country:US
Practice Address - Phone:559-485-0501
Practice Address - Fax:559-485-1313
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10744101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)