Provider Demographics
NPI:1578870549
Name:MEDRANO, AMANDA B (PSYD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 KIRKER PASS RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-1629
Mailing Address - Country:US
Mailing Address - Phone:925-671-0777
Mailing Address - Fax:925-681-1614
Practice Address - Street 1:2151 SALVIO ST STE 301
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-6304
Practice Address - Country:US
Practice Address - Phone:925-671-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY26669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist