Provider Demographics
NPI:1841393881
Name:GRAU, IRIS MARISOL (MD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:MARISOL
Last Name:GRAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IRIS
Other - Middle Name:MARISOL
Other - Last Name:GRAU PABON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:E9 CALLE ROBLE BLANCO
Mailing Address - Street 2:SANTA CLARA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6812
Mailing Address - Country:US
Mailing Address - Phone:787-292-9124
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA
Practice Address - Street 2:PLAZA BUXO #5
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-3655
Practice Address - Fax:787-736-0575
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine