Provider Demographics
NPI:1235249012
Name:GRANT, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GRANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1430 TRUXTUN AVENUE STE 400
Mailing Address - Street 2:ATTENTION ANN LE CLINICA SIERRA VISTA PO BOX 1559
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:704 LEBEC ROAD
Practice Address - Street 2:
Practice Address - City:LEBEC
Practice Address - State:CA
Practice Address - Zip Code:93243
Practice Address - Country:US
Practice Address - Phone:661-248-5250
Practice Address - Fax:661-248-5279
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine