Healthcare Provider Details

I. General information

NPI: 1861326860
Provider Name (Legal Business Name): CHRISTINA MEDRANO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HODENCAMP RD STE 104
THOUSAND OAKS CA
91360-5833
US

IV. Provider business mailing address

20140 ACRE ST
WINNETKA CA
91306-1102
US

V. Phone/Fax

Practice location:
  • Phone: 818-825-4989
  • Fax:
Mailing address:
  • Phone: 818-825-4989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number74355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: