| Grano De Oro Family Mental Health Services | |
|
1920 7th St Las Vegas NM 87701-4956 | |
| (505) 617-6313 | |
| Not Available |
| Full Name | Grano De Oro Family Mental Health Services |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1920 7th St, Las Vegas, New Mexico |
| Authorized Official Name and Position | Rodolfo Fidencio Grano (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 5056176313 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grano De Oro Family Mental Health Services Po Box 1856 Las Vegas NM 87701-1856 Ph: (505) 617-6313 | Grano De Oro Family Mental Health Services 1920 7th St Las Vegas NM 87701-4956 Ph: (505) 617-6313 |
| NPI Number | 1023334083 |
|---|---|
| Provider Enumeration Date | 04/15/2010 |
| Last Update Date | 04/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023334083 | NPI | - | NPPES |
| 17480221 | Medicaid | NM | |
| NM301219 | Other | MEDICARE | |
| 1356452981 | Other | NM | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 0811 (New Mexico) | Primary |
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