Individual
ETHAN D GRANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9300 CAMPUS POINT DR, LA JOLLA, CA 92037-1300
(800) 926-8273
Mailing address
FILE 57326, LOS ANGELES, CA 90074-7326
(800) 926-8273
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA2024-0038
NM
363A00000X
Physician Assistant
Primary
PA67139
CA
Other
Enumeration date
04/20/2023
Last updated
01/28/2026
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