Provider Demographics
NPI:1831202456
Name:HERRERO GRANDA, MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:HERRERO GRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 AVE WINSTON CHURCHILL
Mailing Address - Street 2:EL SENORIAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6604
Mailing Address - Country:US
Mailing Address - Phone:787-760-9638
Mailing Address - Fax:787-760-9689
Practice Address - Street 1:287 AVE WINSTON CHURCHILL
Practice Address - Street 2:EL SENORIAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6604
Practice Address - Country:US
Practice Address - Phone:787-210-2986
Practice Address - Fax:787-760-9638
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12096208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5487OtherPREFER MEDICAL CHOICE
PR500462EOtherMMM
PR88017OtherTRIPLE S
PR88017OtherTRIPLE S OPTIMO
PR9042OtherFIRST MEDICAL
PR9042OtherFIRST MEDICAL
PR88017OtherTRIPLE S OPTIMO