Provider Demographics
NPI:1174822514
Name:MEDRANO, MARIA DELALUZ
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DELALUZ
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 1:817 SE 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-3711
Mailing Address - Country:US
Mailing Address - Phone:863-763-8622
Mailing Address - Fax:
Practice Address - Street 1:817 SE 38TH AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-3711
Practice Address - Country:US
Practice Address - Phone:863-763-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist