Provider Demographics
NPI:1306717673
Name:GRANDSTAFF, ANNA VIKTORIA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:VIKTORIA
Last Name:GRANDSTAFF
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 1:1400 ZILLOCK RD LOT O043
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-9776
Mailing Address - Country:US
Mailing Address - Phone:956-335-1897
Mailing Address - Fax:
Practice Address - Street 1:1400 ZILLOCK RD LOT O043
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-9776
Practice Address - Country:US
Practice Address - Phone:956-335-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCI-2557171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter