Provider Demographics
NPI:1104615061
Name:GRANADOS SARAVIA, GLADIS ESPERANZA II
Entity type:Individual
Prefix:MISS
First Name:GLADIS
Middle Name:ESPERANZA
Last Name:GRANADOS SARAVIA
Suffix:II
Gender:
Credentials:
Other - Prefix:MRS
Other - First Name:GLADIS
Other - Middle Name:ESPERANZA
Other - Last Name:GRANADOS SARAVIA
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:731 S C ST APT B
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-7108
Mailing Address - Country:US
Mailing Address - Phone:561-876-5943
Mailing Address - Fax:
Practice Address - Street 1:731 S C ST APT B
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-7108
Practice Address - Country:US
Practice Address - Phone:561-876-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician