Provider Demographics
NPI:1356382386
Name:MEDRANO, JOE DAVID (RDMS,RVT,,RDCS)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:DAVID
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:RDMS,RVT,,RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 CALLE ALMENDRO
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6404
Mailing Address - Country:US
Mailing Address - Phone:805-501-3060
Mailing Address - Fax:805-493-8036
Practice Address - Street 1:1115 CALLE ALMENDRO
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6404
Practice Address - Country:US
Practice Address - Phone:805-501-3060
Practice Address - Fax:805-493-8036
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15472246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TG567Medicare ID - Type Unspecified