=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215326780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDRANO MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2015
-----------------------------------------------------
Last Update Date | 01/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1830 NW 7TH ST SUITE 200
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-3569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-351-6496
-----------------------------------------------------
Fax | 786-409-2855
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1830 NW 7TH ST SUITE 200
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33125-3569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-351-6496
-----------------------------------------------------
Fax | 786-409-2855
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EDUARDO F MEDRANO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 786-391-8150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | ME33458
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------