Provider Demographics
NPI:1548571623
Name:GRANDON, DEEPA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPA
Middle Name:MARIA
Last Name:GRANDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEEPA
Other - Middle Name:MARIA
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:20199 E VIA DEL ORO
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6269
Mailing Address - Country:US
Mailing Address - Phone:714-697-0862
Mailing Address - Fax:
Practice Address - Street 1:4915 E BASELINE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2965
Practice Address - Country:US
Practice Address - Phone:480-626-6600
Practice Address - Fax:480-626-6604
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 112797207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology