Basic Information
| Provider Information | |||||||||
| NPI: | 1235190620 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANDINETTI | ||||||||
| FirstName: | GAIL | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2202 WILDFLOWER CT | ||||||||
| Address2: | |||||||||
| City: | DALY CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940143524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153108321 | ||||||||
| FaxNumber: | 4155852748 | ||||||||
| Practice Location | |||||||||
| Address1: | 3575 GEARY BLVD | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941183212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153534900 | ||||||||
| FaxNumber: | 4153538101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | E3453 | CA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 480010707 | 01 | RAILROAD RETIREMENT | OTHER | 000E34532 | 05 | CA | MEDICAID | 00034532 | 05 | CA | MEDICAID |