Provider Demographics
NPI:1063665495
Name:BENJAMINO L GRANATO
Entity Type:Organization
Organization Name:BENJAMINO L GRANATO
Other - Org Name:ALPHA DIABETIC SUPPLY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMINO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRANATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-521-5884
Mailing Address - Street 1:P.O. BOX 761801
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245
Mailing Address - Country:US
Mailing Address - Phone:210-521-5884
Mailing Address - Fax:210-521-0074
Practice Address - Street 1:6415 BANDERA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238
Practice Address - Country:US
Practice Address - Phone:210-785-9959
Practice Address - Fax:210-785-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies