Provider Demographics
NPI:1679075493
Name:GRANBERRY MEDICAL CARE, PLLC
Entity type:Organization
Organization Name:GRANBERRY MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/STAFF PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:GUILLERMO
Authorized Official - Last Name:LOPEZ VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-973-8049
Mailing Address - Street 1:900 GRANBERRY ST
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4757
Mailing Address - Country:US
Mailing Address - Phone:281-973-8049
Mailing Address - Fax:281-973-8049
Practice Address - Street 1:900 GRANBERRY ST
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4757
Practice Address - Country:US
Practice Address - Phone:281-973-8049
Practice Address - Fax:281-570-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty