Provider Demographics
NPI:1215039946
Name:MEDRANO, DORA LUZ (RN)
Entity Type:Individual
Prefix:MS
First Name:DORA
Middle Name:LUZ
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 CANDLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7907
Mailing Address - Country:US
Mailing Address - Phone:915-598-4014
Mailing Address - Fax:
Practice Address - Street 1:3607 RIVERA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2415
Practice Address - Country:US
Practice Address - Phone:915-533-7057
Practice Address - Fax:915-533-7197
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253435163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice