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General NPI Number Information
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NPI Number | 1700977782
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Entity Type | Individual
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Provider Name | MR. MIGUEL ANGEL GRAJEDA SR.
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Gender | Male
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7600 BEECHNUT ST MEMORIAL HERMANN HOSPITAL SOUTHWEST
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City | HOUSTON
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State | TX
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Zip | 77074
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Country | US
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Telephone | 713-448-6463
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Fax | 713-448-6570
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Provider Business Mailing Address
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Address Line | 22214 CASCADE SPRINGS DR PO BOX 721676
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City | HOUSTON
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State | TX
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Zip | 77272-1676
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Country | US
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Telephone | 281-392-2854
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Fax | 281-392-7280
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA00013
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License Number State | TX
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