Provider Demographics
NPI:1629873179
Name:GRANADOS CRUZ, SALOMON
Entity type:Individual
Prefix:
First Name:SALOMON
Middle Name:
Last Name:GRANADOS CRUZ
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 1:618 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GIBBON
Mailing Address - State:NE
Mailing Address - Zip Code:68840-4055
Mailing Address - Country:US
Mailing Address - Phone:308-233-1929
Mailing Address - Fax:
Practice Address - Street 1:618 7TH ST
Practice Address - Street 2:
Practice Address - City:GIBBON
Practice Address - State:NE
Practice Address - Zip Code:68840-4055
Practice Address - Country:US
Practice Address - Phone:308-233-1929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty