Provider Demographics
NPI:1790960136
Name:MEDRANO, LUIS ADOLPHO
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ADOLPHO
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ADOLPH
Other - Middle Name:
Other - Last Name:MEDRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1822 JENSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2811
Mailing Address - Country:US
Mailing Address - Phone:559-875-6300
Mailing Address - Fax:
Practice Address - Street 1:1822 JENSEN AVE
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2811
Practice Address - Country:US
Practice Address - Phone:559-875-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator