Healthcare Provider Details

I. General information

NPI: 1720615651
Provider Name (Legal Business Name): PRISCILLA MEDRANO MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 DELA VINA AVE
MONTEREY CA
93940-3974
US

IV. Provider business mailing address

343 DELA VINA AVE
MONTEREY CA
93940-3974
US

V. Phone/Fax

Practice location:
  • Phone: 831-440-7030
  • Fax: 831-647-3004
Mailing address:
  • Phone: 831-440-7030
  • Fax: 831-647-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95210432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: