Healthcare Provider Details

I. General information

NPI: 1649557075
Provider Name (Legal Business Name): YUSIMI GRANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 W 49TH PL SUITE 210
HIALEAH FL
33012-3148
US

IV. Provider business mailing address

1490 W 49TH PL SUITE 210
HIALEAH FL
33012-3148
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-4008
  • Fax: 305-823-4009
Mailing address:
  • Phone: 305-823-4008
  • Fax: 305-823-4009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMA 65704
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: