Provider Demographics
NPI:1659159317
Name:MEDRANO, TERESA N
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:N
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 1:266 E 211TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1500
Mailing Address - Country:US
Mailing Address - Phone:929-284-9285
Mailing Address - Fax:
Practice Address - Street 1:266 E 211TH ST APT 3A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1500
Practice Address - Country:US
Practice Address - Phone:929-284-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator