Provider Demographics
NPI:1710199526
Name:JOSE M MEDRANO MD PC
Entity Type:Organization
Organization Name:JOSE M MEDRANO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-442-4300
Mailing Address - Street 1:2211 W. MAGNOLIA BLVD.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506
Mailing Address - Country:US
Mailing Address - Phone:818-566-1490
Mailing Address - Fax:818-566-1495
Practice Address - Street 1:2211 W. MAGNOLIA BLVD.
Practice Address - Street 2:SUITE 250
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506
Practice Address - Country:US
Practice Address - Phone:818-566-1490
Practice Address - Fax:818-566-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207551207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty