Provider Demographics
NPI:1689416943
Name:GRANADOSCLEMENTS, CHRISSY MARIE
Entity type:Individual
Prefix:DR
First Name:CHRISSY
Middle Name:MARIE
Last Name:GRANADOSCLEMENTS
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 1:10 RESACA SHORE DR S
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566-4133
Mailing Address - Country:US
Mailing Address - Phone:956-408-7919
Mailing Address - Fax:
Practice Address - Street 1:10 RESACA SHORE DR S
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-4133
Practice Address - Country:US
Practice Address - Phone:956-408-7919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider