Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 05195 | PR |
NPI | 1114981578 |
---|---|
Provider Name | Dr. Roberto Grana |
First Address | Corozal, PR 00783 |
Second Address | Guaynabo, PR 00969-5718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 20/11/2008 |