NPIMap

Organization Active NPI

Grano de Oro Family Mental Health Services

  • Clinical Psychologist
  • Las Vegas, NM
National Provider Identifier
1023334083
Registry record updated Apr 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0811 Issued in NM
Legal business name
GRANO DE ORO FAMILY MENTAL HEALTH SERVICES
Practice address
1920 7TH St
Las Vegas, NM 87701-4956
Phone
(505) 617-6313
NPI assigned
Apr 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rodolfo Fidencio Grano, PH.D.
Title
Clinical Psychologist
Phone
(505) 617-6313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 0811 NM Primary

Addresses

Primary practice location

1920 7TH St
Las Vegas, NM 87701-4956

Mailing address

PO Box 1856
Las Vegas, NM 87701-1856
Phone (505) 617-6313

Other identifiers 3

IdentifierTypeStateIssuer
17480221MedicaidNM
NM301219OtherMEDICARE
1356452981OtherNMNPI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271289600000",
    "number": "1023334083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1856",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877011856",
            "telephone_number": "505-617-6313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 7TH ST",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014956",
            "telephone_number": "505-617-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANO DE ORO FAMILY MENTAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-15",
        "last_updated": "2010-04-15",
        "status": "A",
        "authorized_official_last_name": "GRANO",
        "authorized_official_first_name": "RODOLFO",
        "authorized_official_middle_name": "FIDENCIO",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "505-617-6313",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NM",
            "license": "0811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17480221",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "NM301219",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1356452981",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.