Provider Demographics
NPI:1700977782
Name:GRAJEDA, MIGUEL ANGEL SR
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:GRAJEDA
Suffix:SR
Gender:M
Credentials:
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Mailing Address - Street 1:22214 CASCADE SPRINGS DR
Mailing Address - Street 2:PO BOX 721676
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77272-1676
Mailing Address - Country:US
Mailing Address - Phone:281-392-2854
Mailing Address - Fax:281-392-7280
Practice Address - Street 1:7600 BEECHNUT ST
Practice Address - Street 2:MEMORIAL HERMANN HOSPITAL SOUTHWEST
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-448-6463
Practice Address - Fax:713-448-6570
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXSA00013363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical