Ethan D. Granger

Physician Assistant · La Jolla, CA

Individual Active NPI

NPI number 1457048324

Practice location

9300 Campus Point Dr
La Jolla, CA 92037-1300
Phone
(800) 926-8273

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NPI record

NPI
1457048324
Entity type
Individual (Type 1)
Enumeration date
April 20, 2023
Last updated
January 28, 2026
Certified
January 28, 2026
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X PA67139 CA
Physician Assistant 363A00000X PA2024-0038 NM

Mailing address

File 57326
Los Angeles, CA 90074-7326
Phone
(800) 926-8273

Other practice locations (1)

  • 1 University Of New Mexico Msc11 6025, Albuquerque, NM 87131-0001 · (505) 272-5062

About Ethan Granger

Ethan D. Granger is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 9300 Campus Point Dr, La Jolla, CA 92037-1300. The NPI number 1457048324 was assigned on April 20, 2023 and the record was last updated on January 28, 2026.

Ethan Granger lists 2 licenses in the registry: #PA67139 (CA) for Physician Assistant; #PA2024-0038 (NM) for Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Ethan D. Granger?

The NPI number is 1457048324.

What is the phone number of Ethan Granger?

The phone number listed for the practice location is (800) 926-8273.

Where is Ethan Granger located?

9300 Campus Point Dr, La Jolla, CA 92037-1300.

What is the taxonomy code for Ethan Granger?

The primary taxonomy code is 363A00000X – Physician Assistant; 1 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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