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General NPI Number Information
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NPI Number | 1316905334
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Entity Type | Individual
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Provider Name | SAMUEL MEDRANO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 199 E WEBSTER ST
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City | COLUSA
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State | CA
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Zip | 95932-2954
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Country | US
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Telephone | 530-458-3283
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Fax |
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Provider Business Mailing Address
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Address Line | 1990 N CALIFORNIA BLVD SUITE 400
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City | WALNUT CREEK
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State | CA
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Zip | 94596-3742
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Country | US
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Telephone | 925-225-5837
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G68235
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License Number State | CA
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