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General NPI Number Information
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NPI Number | 1275118853
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Entity Type | Individual
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Provider Name | JOSE ALEXI GRANADOS MOLINA COTA/L
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Gender | Male
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 03/16/2021
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Provider Practice Location Address
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Address Line | 7116 FORT HUNT RD
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City | ALEXANDRIA
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State | VA
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Zip | 22307-1900
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Country | US
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Telephone | 703-768-0234
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Fax |
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Provider Business Mailing Address
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Address Line | 2451 MIDTOWN AVE APT 1517
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City | ALEXANDRIA
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State | VA
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Zip | 22303-1440
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Country | US
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Telephone | 719-557-9453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 0131-002464
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License Number State | VA
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