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General NPI Number Information
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NPI Number | 1598911935
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Entity Type | Organization
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Legal Business Name | GRANDA MEDICAL CENTER
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 8200 WEDNESBURY LN STE 102
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City | HOUSTON
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State | TX
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Zip | 77074-2931
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Country | US
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Telephone | 713-988-1838
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 WEDNESBURY LN STE 102
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City | HOUSTON
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State | TX
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Zip | 77074-2931
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Country | US
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Telephone | 713-988-1838
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ENRIQUE B. GRANDA
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Credential | M.D., P.A.
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Telephone | 713-988-0104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E-1858
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License Number State | TX
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