Individual
MARK JASON GRANADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGNP
Contact information
Practice address
857 W CHILDS AVE, MERCED, CA 95341-6862
(209) 722-4842
Mailing address
1910 CUSTOMER CARE WAY, ATWATER, CA 95301-5167
(209) 722-4842
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
95024681
CA
363LG0600X
Gerontology Nurse Practitioner
Primary
95024681
CA
Other
Enumeration date
11/15/2022
Last updated
07/30/2024
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