Individual
MRS. MYRNA LILLIA GRANADOS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH AP
Contact information
Practice address
19270 SONOMA HIGHWAY 12, SONOMA, CA 95476-5414
(707) 939-6070
Mailing address
439 EL DORADO DR, SONOMA, CA 95476-5414
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
HAP 599
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770669715
MEDI-CAL FQHC
CA
Enumeration date
11/08/2016
Last updated
11/08/2016
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