Healthcare Provider Details

I. General information

NPI: 1114949559
Provider Name (Legal Business Name): CECILIA GRANDE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62ND AVE STE 400
SOUTH MIAMI FL
33143-4717
US

IV. Provider business mailing address

9905 SW 68TH CT
PINECREST FL
33156-3050
US

V. Phone/Fax

Practice location:
  • Phone: 305-856-1461
  • Fax: 305-250-5216
Mailing address:
  • Phone: 305-856-1461
  • Fax: 305-662-5884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME71900
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: