Healthcare Provider Details

I. General information

NPI: 1033192380
Provider Name (Legal Business Name): TREVOR HOPE GRANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JUAN CITY HOSPITAL MEDICAL CENTER
SAN JUAN PR
00936
US

IV. Provider business mailing address

364 CALLE SAN JORGE COND. LAS CARMELITAS APT. 12 G
SAN JUAN PR
00912-3301
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-2560
  • Fax:
Mailing address:
  • Phone: 787-725-4374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number3857
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: