Basic Information
| Provider Information | |||||||||
| NPI: | 1649664483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANADOS | ||||||||
| FirstName: | ELEONORA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 595 CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | MARTINEZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945534633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253136098 | ||||||||
| FaxNumber: | 9253136599 | ||||||||
| Practice Location | |||||||||
| Address1: | 13601 SAN PABLO AVE | ||||||||
| Address2: | |||||||||
| City: | SAN PABLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948063818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102319469 | ||||||||
| FaxNumber: | 5103741090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2015 | ||||||||
| LastUpdateDate: | 03/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 689934 | CA | N | Nursing Service Providers | Registered Nurse | 163WP1700X | 689934 | CA | Y | Nursing Service Providers | Registered Nurse | Perinatal |
No ID Information.