Individual
RUDY FIDENCIO GRANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
213 PLAZA ST, N/A, LAS VEGAS, NM 87701-3432
(505) 617-6313
(505) 617-6313
Mailing address
213 PLAZA ST, P.O. BOX 1856, LAS VEGAS, NM 87701-3432
(505) 617-6313
(505) 617-6313
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0811
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17480221
—
NM
Enumeration date
08/31/2006
Last updated
04/05/2013
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