Provider Demographics
NPI:1578225959
Name:GRAND, PAUL JEFFERSON
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JEFFERSON
Last Name:GRAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5893 COPLEY DR FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-7906
Mailing Address - Country:US
Mailing Address - Phone:858-616-5115
Mailing Address - Fax:
Practice Address - Street 1:5893 COPLEY DR FL 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-7906
Practice Address - Country:US
Practice Address - Phone:858-616-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program