Basic Information
| Provider Information | |||||||||
| NPI: | 1609598762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRANT | ||||||||
| FirstName: | DEVIN | ||||||||
| MiddleName: | NATHANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4311 EL PRIETO RD | ||||||||
| Address2: | |||||||||
| City: | ALTADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910013729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266895674 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1020 S ARROYO PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264032794 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2022 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.