Healthcare Provider Details

I. General information

NPI: 1013415744
Provider Name (Legal Business Name): ISABEL GRANADOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 WEST OAKRY BLVD
LAS VEGAS NV
89102
US

IV. Provider business mailing address

1700 N GATEWAY RD
LAS VEGAS NV
89115-6408
US

V. Phone/Fax

Practice location:
  • Phone: 702-822-1253
  • Fax: 702-822-1336
Mailing address:
  • Phone: 702-272-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: