Provider Demographics
NPI:1407576275
Name:GRANADOS, CAROLINA (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24785 STEWART ST RM 201F
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-1721
Mailing Address - Country:US
Mailing Address - Phone:909-558-7295
Mailing Address - Fax:909-558-0495
Practice Address - Street 1:24785 STEWART ST RM 201F
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-1721
Practice Address - Country:US
Practice Address - Phone:909-558-7295
Practice Address - Fax:909-558-0495
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant