Provider Demographics
NPI:1770759904
Name:GRANT, MELINDA ANN (BSRT (T))
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:ANN
Last Name:GRANT
Suffix:
Gender:F
Credentials:BSRT (T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3629
Mailing Address - Country:US
Mailing Address - Phone:619-438-4375
Mailing Address - Fax:
Practice Address - Street 1:6215 DIXIE DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3629
Practice Address - Country:US
Practice Address - Phone:619-438-4375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHT000922202471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy