Provider Demographics
NPI:1649557075
Name:GRANDA, YUSIMI
Entity Type:Individual
Prefix:
First Name:YUSIMI
Middle Name:
Last Name:GRANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 W 49TH PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3148
Mailing Address - Country:US
Mailing Address - Phone:305-823-4008
Mailing Address - Fax:305-823-4009
Practice Address - Street 1:1490 W 49TH PL
Practice Address - Street 2:SUITE 210
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3148
Practice Address - Country:US
Practice Address - Phone:305-823-4008
Practice Address - Fax:305-823-4009
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 65704173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist