Provider Demographics
NPI:1124725148
Name:HERNANDEZ GRANA, ADIA
Entity type:Individual
Prefix:
First Name:ADIA
Middle Name:
Last Name:HERNANDEZ GRANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 GLEASON PKWY
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5054
Mailing Address - Country:US
Mailing Address - Phone:239-471-8746
Mailing Address - Fax:
Practice Address - Street 1:218 GLEASON PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5054
Practice Address - Country:US
Practice Address - Phone:239-471-8746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician