MEDICARE: CRISTINA GRAND PSY.D.ABPP

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	174400000X	Specialist	PY5822	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942223359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA GRAND PSY.D.ABPP

Provider Business Mailing Address
First Line	:	9150 SW 87TH AVE
Second Line	:	SUITE 109
City	:	MIAMI
State	:	FL
Zip	:	33176-2319
Country	:	US
Telephone Number	:	305-596-4663
Fax Number	:	305-596-6947

Provider Business Practice Location Address
First Line	:	9150 SW 87TH AVE
Second Line	:	SUITE 109
City	:	MIAMI
State	:	FL
Zip	:	33176-2319
Country	:	US
Telephone Number	:	305-596-4663
Fax Number	:	305-596-6947

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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