Provider Demographics
NPI:1356941009
Name:AGUIRRE GRANADOS, MANUEL
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:AGUIRRE GRANADOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4617 80TH ST NE APT 3
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-3475
Mailing Address - Country:US
Mailing Address - Phone:425-343-5536
Mailing Address - Fax:
Practice Address - Street 1:4617 80TH ST NE APT 3
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3475
Practice Address - Country:US
Practice Address - Phone:425-343-5536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC14982171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter