Provider Demographics
NPI:1255844387
Name:FUENMAYOR GRANADILLO, CLAUDIA C
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:C
Last Name:FUENMAYOR GRANADILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 SW 115TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6822
Mailing Address - Country:US
Mailing Address - Phone:786-805-0968
Mailing Address - Fax:
Practice Address - Street 1:5330 SW 115TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-6822
Practice Address - Country:US
Practice Address - Phone:786-805-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-11
Last Update Date:2017-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician