Provider Demographics
NPI:1528397692
Name:GRANADOS, ROSITA (RD, LD)
Entity Type:Individual
Prefix:
First Name:ROSITA
Middle Name:
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7173 GOLF COLONY CT APT 204
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8899
Mailing Address - Country:US
Mailing Address - Phone:561-542-8483
Mailing Address - Fax:
Practice Address - Street 1:7173 GOLF COLONY CT APT 204
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-8899
Practice Address - Country:US
Practice Address - Phone:561-542-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5443133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered