Active NPI
Alfredo Segundo Granado Robert
- Behavior Technician
- Tampa, FL
National Provider Identifier
1417730086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 6616 N Church Ave Apt D
Tampa, FL 33614-3976 - Phone
- (813) 576-9120
- NPI assigned
- Aug 16, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
6616 N Church Ave Apt D
Tampa, FL 33614-3976
Mailing address
301 Robert Ave
Lehigh Acres, FL 33936-1623
Phone (502) 379-7457
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1692144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704931200000",
"number": "1417730086",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 ROBERT AVE",
"city": "LEHIGH ACRES",
"state": "FL",
"postal_code": "339361623",
"telephone_number": "502-379-7457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6616 N CHURCH AVE APT D",
"city": "TAMPA",
"state": "FL",
"postal_code": "336143976",
"telephone_number": "813-576-9120"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANADO ROBERT",
"first_name": "ALFREDO",
"middle_name": "SEGUNDO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-16",
"last_updated": "2024-01-11",
"certification_date": "2024-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.