Healthcare Provider Details

I. General information

NPI: 1518891878
Provider Name (Legal Business Name): LISSETTE MEDRANO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 W OLIVE AVE STE F
MERCED CA
95348-1958
US

IV. Provider business mailing address

1530 ELM AVE
ATWATER CA
95301-3516
US

V. Phone/Fax

Practice location:
  • Phone: 209-205-9586
  • Fax:
Mailing address:
  • Phone: 209-422-9024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: