Provider Demographics
NPI:1356538763
Name:GRANILLO, WILLIAM ALFONSO (PHYSICIAN ASSISTAN T)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALFONSO
Last Name:GRANILLO
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTAN T
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4690 N BENGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-0309
Mailing Address - Country:US
Mailing Address - Phone:559-226-1500
Mailing Address - Fax:559-226-1500
Practice Address - Street 1:888 N ALTA AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-3089
Practice Address - Country:US
Practice Address - Phone:559-595-1000
Practice Address - Fax:559-591-6322
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA10807363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical