Provider Demographics
NPI:1235674631
Name:GRANT, LINDA MARLENE
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARLENE
Last Name:GRANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SNEATH LN STE 307
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2349
Mailing Address - Country:US
Mailing Address - Phone:650-244-1444
Mailing Address - Fax:650-244-1447
Practice Address - Street 1:508 7TH AVE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066
Practice Address - Country:US
Practice Address - Phone:650-204-3113
Practice Address - Fax:650-634-8717
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38472OtherTHE LATINO COMMISSION