=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326002528
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMEN A GRAULAU-HERNANDEZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2006
-----------------------------------------------------
Last Update Date | 12/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 CALLE PERSEO CONDOMINIO CENTRO DE ALTAMIRA APT. 5-B
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00920-4204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-781-4158
-----------------------------------------------------
Fax | 787-775-0093
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 CALLE PERSEO CONDOMINIO CENTRO DE ALTAMIRA APT. 5-B
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00920-4204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-781-4158
-----------------------------------------------------
Fax | 787-775-0093
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 6145
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------