MEDICARE: ADILEN GRANADILLO

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	2355S0801X	Speech-Language Assistant	SI4000	FL

General Provider Information

NPI Number	:	1538711676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADILEN GRANADILLO

Provider Business Mailing Address
First Line	:	8013 NW 104TH CT
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-4642
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6862 NW 169TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-4210
Country	:	US
Telephone Number	:	786-615-8426
Fax Number	:

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

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	08/09/2019

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Directions to “ ADILEN GRANADILLO ” Practice Location

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