Provider Demographics
NPI:1568187854
Name:GRANADO ASTUDILLO, MARILYN ORIANA (SA-C)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ORIANA
Last Name:GRANADO ASTUDILLO
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 SW 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5546
Mailing Address - Country:US
Mailing Address - Phone:786-961-2436
Mailing Address - Fax:
Practice Address - Street 1:3940 SW 48TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33023-5546
Practice Address - Country:US
Practice Address - Phone:786-961-2436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-545246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant