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General NPI Number Information
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NPI Number | 1740754720
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Entity Type | Individual
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Provider Name | MICHEL GRANADOS-RUIZ APRN
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Gender | Male
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 1806 N PINE ISALND RD
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City | PLANTATION
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State | FL
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Zip | 33322-5202
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Country | US
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Telephone | 954-474-0110
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Fax | 954-424-9859
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Provider Business Mailing Address
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Address Line | 15525 MIAMI LAKEWAY N APT 107
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City | MIAMI LAKES
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State | FL
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Zip | 33014-5514
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Country | US
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Telephone | 786-647-3300
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9307278
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License Number State | FL
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