Provider Demographics
NPI:1801880786
Name:MEDRANO, JOSE MELITON (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MELITON
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:191 S BUENA VISTA ST
Mailing Address - Street 2:SUITE: 300
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4554
Mailing Address - Country:US
Mailing Address - Phone:818-846-8981
Mailing Address - Fax:818-846-8985
Practice Address - Street 1:191 S BUENA VISTA ST
Practice Address - Street 2:SUITE: 300
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4554
Practice Address - Country:US
Practice Address - Phone:818-846-8981
Practice Address - Fax:818-846-8985
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA75641207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3C3939OtherHEALTH NET
7217574OtherCIGNA
301000301OtherHEALTH PLUS
PRV108999OtherUSFHP
10000017638OtherAFFINITY
160779OtherELDERPLAN
5756619OtherAETNA
58450OtherGUARDIAN
P624577OtherOXFORD
NY0297912OtherGHI
NY01873147Medicaid
1790890OtherUNITED HEALTHCARE
5756619OtherAETNA
NY01873147Medicaid