Provider Demographics
NPI:1578917928
Name:MEDRANO, YESSICA
Entity Type:Individual
Prefix:
First Name:YESSICA
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S LOOP 499 APT R6
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2503
Mailing Address - Country:US
Mailing Address - Phone:714-864-9528
Mailing Address - Fax:
Practice Address - Street 1:800 S ALAMO RD
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TX
Practice Address - Zip Code:78516-9516
Practice Address - Country:US
Practice Address - Phone:956-354-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer