1568430536 NPI number — BELINDA MEDRANO FNP

Table of content: BELINDA MEDRANO FNP (NPI 1568430536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568430536 NPI number — BELINDA MEDRANO FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDRANO
Provider First Name:
BELINDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568430536
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
737 W CHILDS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERCED
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95341-6805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-383-1848
Provider Business Mailing Address Fax Number:
209-383-1296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1510 FLORIDA AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MODESTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95350-4437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-574-1365
Provider Business Practice Location Address Fax Number:
209-574-1372
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  358220 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34561 . This is a "PUBLIC HEALTH NURSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 358220 . This is a "RN LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5565 . This is a "NP LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com