Provider Demographics
NPI:1497838486
Name:MEDINA-RANGEL, DIANA MARCELA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MARCELA
Last Name:MEDINA-RANGEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 N COURT STREET
Mailing Address - Street 2:STE # C
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291
Mailing Address - Country:US
Mailing Address - Phone:559-732-2394
Mailing Address - Fax:559-732-5749
Practice Address - Street 1:518 N COURT ST
Practice Address - Street 2:STE # C
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4913
Practice Address - Country:US
Practice Address - Phone:559-732-2394
Practice Address - Fax:559-732-5749
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4629601OtherMEDICAL