Provider Demographics
NPI:1760973390
Name:GRANADOS, JILLSBURY SAMSON
Entity Type:Individual
Prefix:
First Name:JILLSBURY
Middle Name:SAMSON
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JILLSBURY
Other - Middle Name:SAMSON
Other - Last Name:PINEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6832 SPECKLE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-1839
Mailing Address - Country:US
Mailing Address - Phone:916-305-5757
Mailing Address - Fax:
Practice Address - Street 1:2209 PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4419
Practice Address - Country:US
Practice Address - Phone:888-922-2843
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst