MEDICARE: BRIANA J GRANADO RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86212234	AZ

General Provider Information

NPI Number	:	1154151850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA J GRANADO RD

Provider Business Mailing Address
First Line	:	7865 W BELL RD # 1017
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3803
Country	:	US
Telephone Number	:	623-221-0855
Fax Number	:

Provider Business Practice Location Address
First Line	:	7865 W BELL RD
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-3803
Country	:	US
Telephone Number	:	623-221-0855
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/19/2024

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