Basic Information
| Provider Information | |||||||||
| NPI: | 1255669370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANDI | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 MISSION AVE | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920587102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609674475 | ||||||||
| FaxNumber: | 7604332726 | ||||||||
| Practice Location | |||||||||
| Address1: | 1701 MISSION AVE | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920587102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609674475 | ||||||||
| FaxNumber: | 7604332726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2009 | ||||||||
| LastUpdateDate: | 08/11/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN 244251 | CA | N | Nursing Service Providers | Licensed Vocational Nurse | 163W00000X | 801264 | CA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.