Provider Demographics
NPI:1194162347
Name:GRANADOS, OLIVIA (RN)
Entity type:Individual
Prefix:MRS
First Name:OLIVIA
Middle Name:
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:OLIVIA
Other - Middle Name:
Other - Last Name:MONTANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:31872 COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6773
Mailing Address - Country:US
Mailing Address - Phone:949-499-7146
Mailing Address - Fax:
Practice Address - Street 1:31872 COAST HWY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6773
Practice Address - Country:US
Practice Address - Phone:949-499-7146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA724972163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse