Grano, Rudy Fidencio

Grano, Rudy Fidencio is an sole proprietor health care provider with primary practice located at 213 Plaza St N/A, Las Vegas NM 87701-3432. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Grano, Rudy Fidencio can be contacted via phone (505) 617-6313.

Contact Information

Primary practice address
213 Plaza St N/A Las Vegas NM 87701-3432
Fax: (505) 617-6313
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 0811 New Mexico

Profile Details

NPI number 1356452981
LBN Legal business name Grano, Rudy Fidencio
Credentials PSYD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 31st, 2006
Last updated Apr 5th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356452981 NPPES
New Mexico MEDICAID 17480221

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