Provider Demographics
NPI:1114981578
Name:GRANA, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:GRANA
Suffix:
Gender:M
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:EXT. SYLVIA D-41
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-802-3713
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE COLTON
Practice Address - Street 2:AUTONOMOUS MUNICIPALITY OF GUAYMABO CITY ELA,PR
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5718
Practice Address - Country:US
Practice Address - Phone:787-720-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR05195207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine