Provider Demographics
NPI:1922605997
Name:MEDRANO, FRANCISCO ALBERTO (MSLAC)
Entity Type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:ALBERTO
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:MSLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GRANT PL
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1921
Mailing Address - Country:US
Mailing Address - Phone:516-637-1378
Mailing Address - Fax:
Practice Address - Street 1:30 GRANT PL
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1921
Practice Address - Country:US
Practice Address - Phone:516-637-1378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006620171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty