Healthcare Provider Details

I. General information

NPI: 1861316390
Provider Name (Legal Business Name): CARLOS GRANDEZ CHERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4666 34TH ST S APT A1
ARLINGTON VA
22206-1739
US

IV. Provider business mailing address

4666 34TH ST S APT A1
ARLINGTON VA
22206-1739
US

V. Phone/Fax

Practice location:
  • Phone: 313-502-4639
  • Fax:
Mailing address:
  • Phone: 313-502-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: