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General NPI Number Information
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NPI Number | 1528642097
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Entity Type | Individual
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Provider Name | VICTORIA MEDRANO
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Gender | Female
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 05/08/2024
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Provider Practice Location Address
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Address Line | 3499 10TH ST
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City | RIVERSIDE
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State | CA
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Zip | 92501-3617
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Country | US
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Telephone | 951-955-1560
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Fax |
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Provider Business Mailing Address
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Address Line | 222 E HUNTINGTON DR STE 213
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City | MONROVIA
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State | CA
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Zip | 91016-8013
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Country | US
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Telephone | 866-727-8274
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | MPSS-KHRAIN
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-KHRAIN
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License Number State | CA
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