Provider Demographics
NPI:1770628158
Name:MEDRANO, ART VASQUEZ (PSYD)
Entity Type:Individual
Prefix:MR
First Name:ART
Middle Name:VASQUEZ
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7368 GREENHAVEN AVE APT 34
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7314
Mailing Address - Country:US
Mailing Address - Phone:909-010-1856
Mailing Address - Fax:
Practice Address - Street 1:7368 GREENHAVEN AVE APT 34
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7314
Practice Address - Country:US
Practice Address - Phone:909-010-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health