Provider Demographics
NPI:1144606708
Name:GRAJALES, JOSE JOAQUIN SR (RN BSN COHN)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JOAQUIN
Last Name:GRAJALES
Suffix:SR
Gender:M
Credentials:RN BSN COHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250106
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0106
Mailing Address - Country:US
Mailing Address - Phone:787-510-9165
Mailing Address - Fax:
Practice Address - Street 1:241 CALLE BARBOSA
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-641-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22706163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice