Provider Demographics
NPI:1679750327
Name:GRANTHOM, MARIA SEMBRANO (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:SEMBRANO
Last Name:GRANTHOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1870
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95077-1870
Mailing Address - Country:US
Mailing Address - Phone:831-728-0222
Mailing Address - Fax:831-707-2777
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
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A335320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A335320Medicaid
CAA87890Medicare UPIN
CA00A335320Medicaid