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NPI Code Detail

MEDICARE: IRIS J MEDRANO

MEDICARE: IRIS J MEDRANO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1578015954
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRIS J MEDRANO
Provider Business Mailing Address
First Line : 3621 MARION LN
Second Line :
City : LAS CRUCES
State : NM
Zip : 88012-7579
Country : US
Telephone Number : 575-520-6074
Fax Number : 575-652-4104
Provider Business Practice Location Address
First Line : 3621 MARION LN
Second Line :
City : LAS CRUCES
State : NM
Zip : 88012-7579
Country : US
Telephone Number : 575-520-6074
Fax Number : 505-929-6200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2016
Last Update Date : 01/20/2023

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1144847179 — LITISHIA NYKEETA SALARY
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88012-7579
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1306569470 — JOCELYN DIANE LIRA
Practice Location Address:
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88012-7579
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Practice Fax: 505-929-6200

Directions to “ IRIS J MEDRANO ” Practice Location

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