Provider Demographics
NPI:1992723514
Name:GRANT-ANDERSON, BETTY S (MD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:S
Last Name:GRANT-ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:SUE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8192
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-8192
Mailing Address - Country:US
Mailing Address - Phone:951-652-8000
Mailing Address - Fax:951-929-6431
Practice Address - Street 1:949 CALHOUN PL
Practice Address - Street 2:SUITE D
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4403
Practice Address - Country:US
Practice Address - Phone:951-652-8000
Practice Address - Fax:951-929-6431
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55694207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G556940Medicaid
CA00G556940Medicaid