Provider Demographics
NPI:1669739827
Name:GRANATA, ANGELA MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:GRANATA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7455 W WASHINGTON AVE STE 460
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4338
Mailing Address - Country:US
Mailing Address - Phone:702-765-0884
Mailing Address - Fax:702-765-0862
Practice Address - Street 1:10105 BANBURRY CROSS DR STE 445
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6645
Practice Address - Country:US
Practice Address - Phone:702-765-0884
Practice Address - Fax:702-765-0862
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2007213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1669739827Medicaid
NVV110850Medicare PIN