Healthcare Provider Details

I. General information

NPI: 1538096235
Provider Name (Legal Business Name): CHRISTA ROSE MEDRANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 3RD ST
SAN FRANCISCO CA
94107-1214
US

IV. Provider business mailing address

1201 FUNSTON AVE APT 207
SAN FRANCISCO CA
94122-2133
US

V. Phone/Fax

Practice location:
  • Phone: 415-281-5100
  • Fax:
Mailing address:
  • Phone: 505-910-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-11354
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: