Healthcare Provider Details

I. General information

NPI: 1316905334
Provider Name (Legal Business Name): SAMUEL MEDRANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 E WEBSTER ST
COLUSA CA
95932-2954
US

IV. Provider business mailing address

1990 N CALIFORNIA BLVD SUITE 400
WALNUT CREEK CA
94596-3742
US

V. Phone/Fax

Practice location:
  • Phone: 530-458-3283
  • Fax:
Mailing address:
  • Phone: 925-225-5837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG68235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: