Provider Demographics
NPI:1871281949
Name:GRANADOS-LAYOSO, SAMANTHA KATRINA (FNP-BC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATRINA
Last Name:GRANADOS-LAYOSO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:KATRINA
Other - Last Name:GRANADOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4934 RIDGEFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-6432
Mailing Address - Country:US
Mailing Address - Phone:818-658-0570
Mailing Address - Fax:
Practice Address - Street 1:2160 JEFFERSON ST STE 260
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1252
Practice Address - Country:US
Practice Address - Phone:072-590-7007
Practice Address - Fax:707-252-2645
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily