Provider Demographics
NPI:1003476789
Name:MEDRANO, ASTRID BELEM
Entity Type:Individual
Prefix:
First Name:ASTRID
Middle Name:BELEM
Last Name:MEDRANO
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 1:2201 INWOOD ROAD MONCRIEF BUILDING 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7320
Mailing Address - Country:US
Mailing Address - Phone:214-645-8525
Mailing Address - Fax:214-645-0977
Practice Address - Street 1:2201 INWOOD ROAD MONCRIEF BUILDING 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7320
Practice Address - Country:US
Practice Address - Phone:214-645-8525
Practice Address - Fax:214-645-0977
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-16
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141881363LF0000X
TX8416062085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty