Provider Demographics
NPI:1003063819
Name:MEDRANO, SHERRY HEFNER (CPNP)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:HEFNER
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 S. SAN JULIAN ST
Mailing Address - Street 2:BLDG 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3142
Mailing Address - Country:US
Mailing Address - Phone:213-765-2800
Mailing Address - Fax:213-765-3861
Practice Address - Street 1:456 S MATHEWS ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4326
Practice Address - Country:US
Practice Address - Phone:323-780-6502
Practice Address - Fax:323-780-6685
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269220363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool