Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME71900 | FL |
NPI | 1114949559 |
---|---|
Provider Name | Dr. Cecilia Grande |
First Address | Pinecrest, FL 33156-3050 |
Second Address | South Miami, FL 33143-4717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 03/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
259082400 | (05) | FL |
H67390 | (02) | FL |