Provider Demographics
NPI:1417066432
Name:MARIA SEMBRANO GRANTHOM, M.D. INC.
Entity Type:Organization
Organization Name:MARIA SEMBRANO GRANTHOM, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:SEMBRANO
Authorized Official - Last Name:GRANTHOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-728-1489
Mailing Address - Street 1:208 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3135
Mailing Address - Country:US
Mailing Address - Phone:831-728-1489
Mailing Address - Fax:831-728-0936
Practice Address - Street 1:208 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3135
Practice Address - Country:US
Practice Address - Phone:831-728-1489
Practice Address - Fax:831-728-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33532207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A335320Medicaid
CA00A335320Medicare ID - Type Unspecified
CAA87890Medicare UPIN