Provider Demographics
NPI:1891215703
Name:MEDRANO, JORGE ANTONIO JR (LVN)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ANTONIO
Last Name:MEDRANO
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ST PAUL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-5686
Mailing Address - Country:US
Mailing Address - Phone:213-482-6400
Mailing Address - Fax:213-482-0276
Practice Address - Street 1:600 ST PAUL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017
Practice Address - Country:US
Practice Address - Phone:213-482-6400
Practice Address - Fax:213-482-0276
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN688015164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse