Provider Demographics
NPI:1427572874
Name:MEDRANO, JUAN M
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2323
Mailing Address - Country:US
Mailing Address - Phone:831-424-4828
Mailing Address - Fax:831-424-5838
Practice Address - Street 1:1083 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2323
Practice Address - Country:US
Practice Address - Phone:831-424-4828
Practice Address - Fax:831-424-5838
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60275101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor