Provider Demographics
NPI:1598496267
Name:GRANADOS, DANIEL A (CSFA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:GRANADOS
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 VIA DE CASAS SUR APT 204
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8850
Mailing Address - Country:US
Mailing Address - Phone:954-599-7778
Mailing Address - Fax:
Practice Address - Street 1:20 VIA DE CASAS SUR APT 204
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8850
Practice Address - Country:US
Practice Address - Phone:954-599-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
210887246ZC0007X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant