Provider Demographics
NPI:1356390181
Name:GRANDO, SERGEI (MD, PHD, DSCI)
Entity type:Individual
Prefix:DR
First Name:SERGEI
Middle Name:
Last Name:GRANDO
Suffix:
Gender:M
Credentials:MD, PHD, DSCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15507 ORCHID AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1933
Mailing Address - Country:US
Mailing Address - Phone:949-552-4211
Mailing Address - Fax:
Practice Address - Street 1:15374 ALTON PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2362
Practice Address - Country:US
Practice Address - Phone:949-552-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61043207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG45066Medicare UPIN