Individual
JACKELINE A DE LA GRANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1490 W 49TH PL, SUITE 210, HIALEAH, FL 33012-3148
(305) 823-4008
Mailing address
4444 SW 136TH PL, MIAMI, FL 33175-3721
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
MA50607
FL
Other
Enumeration date
05/27/2008
Last updated
05/27/2008
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