Provider Demographics
NPI:1952100216
Name:GRANILLO, SAMUEL P III (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:P
Last Name:GRANILLO
Suffix:III
Gender:
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38397 INNOVATION CT STE 103
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2631
Mailing Address - Country:US
Mailing Address - Phone:951-579-0758
Mailing Address - Fax:
Practice Address - Street 1:38397 INNOVATION CT STE 103
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2631
Practice Address - Country:US
Practice Address - Phone:951-579-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist