Provider Demographics
NPI:1508902313
Name:GRANDA-RODRIGUEZ, GLADYS BLANCA (PYS PHD)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:BLANCA
Last Name:GRANDA-RODRIGUEZ
Suffix:
Gender:F
Credentials:PYS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 NE 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4522
Mailing Address - Country:US
Mailing Address - Phone:305-573-9898
Mailing Address - Fax:305-573-3711
Practice Address - Street 1:258 NE 27TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4522
Practice Address - Country:US
Practice Address - Phone:305-573-9898
Practice Address - Fax:305-573-3711
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY -6236170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4571AMedicare PIN