Provider Demographics
NPI:1508005646
Name:GRANADOS, REGINA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:M
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 RIVER ROCK DR
Mailing Address - Street 2:SUITE 221
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2094
Mailing Address - Country:US
Mailing Address - Phone:916-605-8654
Mailing Address - Fax:916-358-8488
Practice Address - Street 1:1002 RIVER ROCK DR
Practice Address - Street 2:SUITE 221
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2094
Practice Address - Country:US
Practice Address - Phone:916-605-8654
Practice Address - Fax:916-358-8488
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21246103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist