MEDICARE: MARILYN ORIANA GRANADO ASTUDILLO SA-C

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	246ZC0007X	Surgical Assistant	22-545	FL

General Provider Information

NPI Number	:	1568187854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN ORIANA GRANADO ASTUDILLO SA-C

Provider Business Mailing Address
First Line	:	3940 SW 48TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-5546
Country	:	US
Telephone Number	:	786-961-2436
Fax Number	:

Provider Business Practice Location Address
First Line	:	3940 SW 48TH AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33023-5546
Country	:	US
Telephone Number	:	786-961-2436
Fax Number	:

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

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	10/10/2022

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Directions to “ MARILYN ORIANA GRANADO ASTUDILLO SA-C” Practice Location

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