Healthcare Provider Details

I. General information

NPI: 1922418060
Provider Name (Legal Business Name): GRAND HEALTH CARE CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N BAYSHORE DR SUITE 217
MIAMI FL
33132-1180
US

IV. Provider business mailing address

1717 N BAYSHORE DR SUITE 217
MIAMI FL
33132-1180
US

V. Phone/Fax

Practice location:
  • Phone: 305-728-0505
  • Fax: 305-728-0515
Mailing address:
  • Phone: 305-728-0505
  • Fax: 305-728-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: A JABBARI
Title or Position: MANAGING EMPLOYEE
Credential:
Phone: 305-728-0505