MEDICARE: ELEANOR MEDRANO-COLON

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1992958938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR MEDRANO-COLON

Provider Business Mailing Address
First Line	:	2343 E HOME AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-3712
Country	:	US
Telephone Number	:	559-312-0802
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 N FULTON ST STE 101
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93728-3405
Country	:	US
Telephone Number	:	559-486-6080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	11/03/2008

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