Provider Demographics
NPI:1740156249
Name:RODRIGUEZ-MEDRANO, PRISCILA VIVIANA
Entity type:Individual
Prefix:
First Name:PRISCILA
Middle Name:VIVIANA
Last Name:RODRIGUEZ-MEDRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2226
Mailing Address - Country:US
Mailing Address - Phone:831-254-1252
Mailing Address - Fax:
Practice Address - Street 1:201 BREWINGTON AVE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4022
Practice Address - Country:US
Practice Address - Phone:831-728-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health