Provider Demographics
NPI:1720180995
Name:GRANBERG, JULIET PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIET
Middle Name:PATRICIA
Last Name:GRANBERG
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 1:2915 TELEGRAPH AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705
Mailing Address - Country:US
Mailing Address - Phone:510-843-4077
Mailing Address - Fax:510-841-6772
Practice Address - Street 1:2915 TELEGRAPH AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-843-4077
Practice Address - Fax:510-841-6772
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA023706208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1403416Medicare UPIN
CA00A023706Medicare ID - Type Unspecified