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General NPI Number Information
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NPI Number | 1861606246
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Entity Type | Organization
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Legal Business Name | TOMAS R. GRANADOS, PSY.D.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 7000 JEFFERSON ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4313
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Country | US
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Telephone | 505-797-0810
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Fax | 505-797-0814
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Provider Business Mailing Address
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Address Line | PO BOX 93874
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City | ALBUQUERQUE
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State | NM
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Zip | 87199-3874
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Country | US
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Telephone | 505-797-0810
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Fax | 505-797-0814
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Authorized Official
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Title or Position | OWNER
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Name | DR. TOMAS REFUGIO GRANADOS
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Credential | PSY.D.
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Telephone | 505-797-0810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 702
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 702
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License Number State | NM
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