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General NPI Number Information
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NPI Number | 1790231637
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Entity Type | Individual
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Provider Name | JOCHEN A GRANJA VASQUEZ D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 1 RICHLAND MEDICAL PARK DR STE 100
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City | COLUMBIA
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State | SC
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Zip | 29203-6834
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Country | US
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Telephone | 803-434-6095
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Fax | 803-758-0120
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-695-6697
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 92600
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License Number State | SC
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