Healthcare Provider Details

I. General information

NPI: 1720620420
Provider Name (Legal Business Name): MARIA CARMEN MEDRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 OSWELL ST STE 119
BAKERSFIELD CA
93306-3172
US

IV. Provider business mailing address

2621 OSWELL ST STE 119
BAKERSFIELD CA
93306-3172
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-6750
  • Fax: 661-872-3001
Mailing address:
  • Phone: 661-868-8675
  • Fax: 661-872-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: