Doctor Name: | KELLY GRANT |
NPI Number: | 1194042721 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RD, NC |
License Number: | ND 53 |
Business Practice Address: | 359 Middlefield Rd Palo Alto, CA - 943011345 |
Business Phone Number: | 6503237345 |
Business Fax Number: | |
Mailing Address: | 359 Middlefield Rd, PALO ALTO |
State: | CA |
Postal Code: | 943011345 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/21/2010 |
NPI Last Update Date: | 04/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | ND 53 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |