Provider Demographics
NPI:1437394020
Name:JOACHIM W. GRANZOW, M.D., M.P.H., INC.
Entity Type:Organization
Organization Name:JOACHIM W. GRANZOW, M.D., M.P.H., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-874-9709
Mailing Address - Street 1:PO BOX 783
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-0783
Mailing Address - Country:US
Mailing Address - Phone:310-882-6261
Mailing Address - Fax:310-882-6260
Practice Address - Street 1:23365 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3736
Practice Address - Country:US
Practice Address - Phone:310-882-6261
Practice Address - Fax:310-882-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA67284Medicare PIN