Provider Demographics
NPI:1083193254
Name:CHAVARRIA MEDRANO, ALMA GRACIELA (MS)
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:GRACIELA
Last Name:CHAVARRIA MEDRANO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 N MERIDIAN AVE SPC 262
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-1329
Mailing Address - Country:US
Mailing Address - Phone:909-915-7908
Mailing Address - Fax:
Practice Address - Street 1:243 N MERIDIAN AVE SPC 262
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-1329
Practice Address - Country:US
Practice Address - Phone:909-915-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician