Healthcare Provider Details

I. General information

NPI: 1134701154
Provider Name (Legal Business Name): CHRISTOPHER GRADY MARIANO JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2021
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BONAVENTURE WAY STE 119
SUGAR LAND TX
77479-8005
US

IV. Provider business mailing address

800 BONAVENTURE WAY STE 119
SUGAR LAND TX
77479-8005
US

V. Phone/Fax

Practice location:
  • Phone: 832-730-7246
  • Fax: 844-302-5696
Mailing address:
  • Phone: 832-730-7246
  • Fax: 844-302-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberW0958
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: