Provider Demographics
NPI:1952437535
Name:GRANADOS, MARIA AUXILIADORA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:AUXILIADORA
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9615 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2973
Mailing Address - Country:US
Mailing Address - Phone:305-599-8022
Mailing Address - Fax:305-599-8023
Practice Address - Street 1:9615 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2973
Practice Address - Country:US
Practice Address - Phone:305-599-8022
Practice Address - Fax:305-599-8023
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94633208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274336100Medicaid