Healthcare Provider Details

I. General information

NPI: 1790231637
Provider Name (Legal Business Name): JOCHEN A GRANJA VASQUEZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOCHEN GRANJA

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RICHLAND MEDICAL PARK DR STE 100
COLUMBIA SC
29203-6834
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6095
  • Fax: 803-758-0120
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number92600
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: