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General NPI Number Information
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NPI Number | 1639604606
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Entity Type | Organization
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Legal Business Name | ROSARIO GRAU MD PA
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 03/08/2018
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Provider Practice Location Address
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Address Line | 6542 REGENCY LN SUITE 205
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-7847
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Country | US
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Telephone | 612-225-0176
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Fax | 612-808-6738
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Provider Business Mailing Address
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Address Line | 6542 REGENCY LN SUITE 205
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-7847
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Country | US
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Telephone | 612-225-0176
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Fax | 612-808-6738
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MARIA DEL ROSARIO GRAU
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Credential | MD
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Telephone | 612-225-0176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 34597
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License Number State | MN
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