MEDICARE: DANETTE ORACOY GRAVADOR RN, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0400X	Rehabilitation Registered Nurse	599233	TX

General Provider Information

NPI Number	:	1215764089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANETTE ORACOY GRAVADOR RN, BC

Provider Business Mailing Address
First Line	:	7403 WURZBACH RD APT 131
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4494
Country	:	US
Telephone Number	:	210-396-2785
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 MERTON MINTER ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4404
Country	:	US
Telephone Number	:	210-617-5300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2024
Last Update Date	:	09/17/2024

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