Provider Demographics
NPI:1417730086
Name:GRANADO ROBERT, ALFREDO SEGUNDO
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:SEGUNDO
Last Name:GRANADO ROBERT
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 1:301 ROBERT AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-1623
Mailing Address - Country:US
Mailing Address - Phone:502-379-7457
Mailing Address - Fax:
Practice Address - Street 1:6616 N CHURCH AVE APT D
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3976
Practice Address - Country:US
Practice Address - Phone:813-576-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician