Healthcare Provider Details

I. General information

NPI: 1144606708
Provider Name (Legal Business Name): JOSE JOAQUIN GRAJALES SR. RN BSN COHN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 CALLE BARBOSA
MOCA PR
00676
US

IV. Provider business mailing address

PO BOX 250106
AGUADILLA PR
00604-0106
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-0773
  • Fax:
Mailing address:
  • Phone: 787-510-9165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number22706
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: