1063515161 NPI number — JUAN CARLOS MEDRANO MD

Table of content: JUAN CARLOS MEDRANO MD (NPI 1063515161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063515161 NPI number — JUAN CARLOS MEDRANO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDRANO
Provider First Name:
JUAN
Provider Middle Name:
CARLOS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEDRANO
Provider Other First Name:
JUAN
Provider Other Middle Name:
CARLOS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063515161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7400 FANNIN ST.
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77054-1935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-797-1100
Provider Business Mailing Address Fax Number:
713-797-9757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7400 FANNIN ST.
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77054-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-797-1100
Provider Business Practice Location Address Fax Number:
713-797-9757
Provider Enumeration Date:
09/06/2006

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: 207V00000X , with the licence number:  F-2803 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00723224 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 034908601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 034908602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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