Individual
AMANDA B GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11303 W WASHINGTON BLVD, SUITE 100, LOS ANGELES, CA 90066-6003
(310) 391-7281
(310) 390-9851
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
(310) 319-7281
(310) 390-9851
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
43348
CO
207R00000X
Internal Medicine Physician
C54102
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016470
KAISER-COMMERCIAL NUMBER
—
Enumeration date
03/07/2007
Last updated
12/02/2010
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