Provider Demographics
NPI:1114949559
Name:GRANDE, CECILIA (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:
Last Name:GRANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 SW 68TH CT
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3050
Mailing Address - Country:US
Mailing Address - Phone:305-856-1461
Mailing Address - Fax:305-662-5884
Practice Address - Street 1:7000 SW 62ND AVE STE 400
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4717
Practice Address - Country:US
Practice Address - Phone:305-856-1461
Practice Address - Fax:305-250-5216
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71900207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259082400Medicaid
FL259082400Medicaid
FLH67390Medicare UPIN