Provider Demographics
NPI:1265028476
Name:TORRES MEDRANO, MIGUEL (NP)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:TORRES MEDRANO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 COLUMBUS AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76701-1322
Mailing Address - Country:US
Mailing Address - Phone:254-405-4537
Mailing Address - Fax:855-226-8732
Practice Address - Street 1:600 COLUMBUS AVE STE 106
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1322
Practice Address - Country:US
Practice Address - Phone:254-405-4537
Practice Address - Fax:855-226-8732
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1021115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily