Healthcare Provider Details

I. General information

NPI: 1346261203
Provider Name (Legal Business Name): SONIA CECILIA GRANNUM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

18950 SW 12TH ST
PEMBROKE PINES FL
33029-6019
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6602
  • Fax: 305-585-0037
Mailing address:
  • Phone: 954-437-0720
  • Fax: 954-433-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberARNP966912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: