Provider Demographics
NPI:1063572915
Name:GRANESE, MARSHA FUNDERBURK (MD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:FUNDERBURK
Last Name:GRANESE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:22032 EL PASEO
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3947
Mailing Address - Country:US
Mailing Address - Phone:949-589-6487
Mailing Address - Fax:949-589-6485
Practice Address - Street 1:22032 EL PASEO
Practice Address - Street 2:SUITE 200
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3947
Practice Address - Country:US
Practice Address - Phone:949-589-6487
Practice Address - Fax:949-589-6485
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2021-11-02
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Provider Licenses
StateLicense IDTaxonomies
CAA83534207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology