Healthcare Provider Details

I. General information

NPI: 1952246555
Provider Name (Legal Business Name): XAVIER ANDRES GRANDES ANDRADE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GRANT STREET
BRIDGEPORT CT
06610
US

IV. Provider business mailing address

URBANIZACION BOSQUES DEL SALADO MZ.302 V.7
GUAYAQUIL GUAYAQUIL
090512
EC

V. Phone/Fax

Practice location:
  • Phone: 203-384-3792
  • Fax: 203-384-4294
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: