Provider Demographics
NPI:1427726678
Name:GRADOS, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GRADOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 BROADWAY EXT STE 226
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-9038
Mailing Address - Country:US
Mailing Address - Phone:405-200-8677
Mailing Address - Fax:
Practice Address - Street 1:7301 BROADWAY EXT STE 226
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9038
Practice Address - Country:US
Practice Address - Phone:405-200-8677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKPRIVATEOtherHOME HEALTH AGENCY THAT ONLY ACCEPTS PRIVATE PAY AS OF NOW.