Provider Demographics
NPI:1306197926
Name:GRANADO, NIGGI
Entity Type:Individual
Prefix:
First Name:NIGGI
Middle Name:
Last Name:GRANADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 S DURANGO DR
Mailing Address - Street 2:APARTMENT 175
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2650
Mailing Address - Country:US
Mailing Address - Phone:702-332-4596
Mailing Address - Fax:
Practice Address - Street 1:5615 CAMERON ST
Practice Address - Street 2:SUITE 7
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2233
Practice Address - Country:US
Practice Address - Phone:702-883-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20121155706101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor