Healthcare Provider Details

I. General information

NPI: 1396266656
Provider Name (Legal Business Name): RITA MARIA MEDRANO JUAREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/18/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY STREET ALDRICH BUILDING ROOM 126
PROVIDENCE RI
02903
US

IV. Provider business mailing address

593 EDDY STREET ALDRICH BUILDING ROOM 126
PROVIDENCE RI
02903
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4000
  • Fax:
Mailing address:
  • Phone: 401-444-8450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2020038090
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10059585
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLP06517
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: