Most Relevant Information
Provider Data
| NPI Number: | 1003519463 |
| Provider Name: | IRVIN GRANSTROM |
| Entity Type: | Individual |
| Taxonomy Code: | 225400000X |
| Specialty: | Rehabilitation Practitioner |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/24/2023 |
| Last Updated: | 03/24/2023 |
Provider Practice Location
3680 N RANCHO DR
LAS VEGAS
NV
891303180
Practice Location Phone/Fax
| Phone: | 7026465437 |
| Fax: |
Provider Mailing Location
3680 N RANCHO DR
LAS VEGAS
NV
891303180
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |