Provider Demographics
NPI:1164106985
Name:MEDRANO, ROGER NAPOLEON
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:NAPOLEON
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:NAPOLEON
Other - Last Name:MEDRANO CLAROS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13380 ALPINE ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-0866
Mailing Address - Country:US
Mailing Address - Phone:951-750-0736
Mailing Address - Fax:
Practice Address - Street 1:13380 ALPINE ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-0866
Practice Address - Country:US
Practice Address - Phone:951-750-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1155781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical