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General NPI Number Information
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NPI Number | 1023735164
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Entity Type | Organization
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Legal Business Name | MEDRANO AND ASSOCIATES
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Dates
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Enumeration Date | 10/19/2022
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 564 W RANDOLPH ST
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City | CHICAGO
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State | IL
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Zip | 60661-2218
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Country | US
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Telephone | 708-990-0796
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 W GRANVILLE AVE APT 820
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City | CHICAGO
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State | IL
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Zip | 60660-5050
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | DIAN MEDRANO
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Credential |
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Telephone | 708-990-0796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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