Provider Demographics
NPI:1265784698
Name:GRANADOS, ANGELA MARIE (CNM)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12462 PUTNAM ST
Mailing Address - Street 2:SUITE #303
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1048
Mailing Address - Country:US
Mailing Address - Phone:562-789-5440
Mailing Address - Fax:562-789-4440
Practice Address - Street 1:12462 PUTNAM ST
Practice Address - Street 2:SUITE #303
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1048
Practice Address - Country:US
Practice Address - Phone:562-789-5440
Practice Address - Fax:562-789-4440
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22484363LW0102X
CA2023367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health