Healthcare Provider Details

I. General information

NPI: 1497843759
Provider Name (Legal Business Name): ROSARIO HAYDEE MEDRANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1149 S BROADWAY FL 5
LOS ANGELES CA
90015-2213
US

IV. Provider business mailing address

550 S VERMONT AVE FL 7
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 213-485-3375
  • Fax: 213-485-3429
Mailing address:
  • Phone: 213-738-4276
  • Fax: 213-380-3680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS13118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: