Provider Demographics
NPI:1154151850
Name:GRANADO, BRIANA J (RD)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:J
Last Name:GRANADO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7865 W BELL RD # 1017
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3803
Mailing Address - Country:US
Mailing Address - Phone:623-221-0855
Mailing Address - Fax:
Practice Address - Street 1:7865 W BELL RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3803
Practice Address - Country:US
Practice Address - Phone:623-221-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86212234133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered