Provider Demographics
NPI:1568210789
Name:BEIZA GRANADOS, ROSA HELIBERIA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:HELIBERIA
Last Name:BEIZA GRANADOS
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 1:600 LOUISE WAY APT 106
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3512
Mailing Address - Country:US
Mailing Address - Phone:707-721-7577
Mailing Address - Fax:
Practice Address - Street 1:600 LOUISE WAY APT 106
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-3512
Practice Address - Country:US
Practice Address - Phone:707-721-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73364225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist