Provider Demographics
NPI:1932251378
Name:MEDRANO, ALONSO
Entity Type:Individual
Prefix:MR
First Name:ALONSO
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2154 W PUEBLO AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-4552
Mailing Address - Country:US
Mailing Address - Phone:707-320-8050
Mailing Address - Fax:
Practice Address - Street 1:709 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2920
Practice Address - Country:US
Practice Address - Phone:707-255-0966
Practice Address - Fax:707-255-3110
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered174400000XOther Service ProvidersSpecialist