Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan D Granger

Individual provider Physician Assistant · NPI 1457048324

Ethan D Granger is a Physician Assistant in LA Jolla, California. Qualified in 2024, 2 years ago. Practices with Regents of the University of California, a 2,061-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in California and New Mexico.

Years since qualifying
2
Licensed in
CA, NM
In the registry since
2023
Specialties on file
2
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Practice location Address checks out

9300 Campus Point Dr
LA Jolla, CA 92037-1300
Phone: (800) 926-8273
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA67139 (CA)
Physician Assistant Taxonomy 363A00000X · Licence PA2024-0038 (NM)

Record details

NPI number1457048324
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedApril 20, 2023
Last updated in NPPESJanuary 28, 2026
Certification dateJanuary 28, 2026
Mailing addressFile 57326, Los Angeles, CA 90074-7326

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Regents Of The University Of California — 2061 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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