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General NPI Number Information
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NPI Number | 1942789367
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Entity Type | Individual
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Provider Name | JOEL PHILLIP MEDRANO
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Gender | Male
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 1665 N AVONDALE BLVD
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City | AVONDALE
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State | AZ
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Zip | 85392-5006
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Country | US
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Telephone | 602-933-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 20508 W DANIEL PL
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City | BUCKEYE
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State | AZ
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Zip | 85396-3649
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Country | US
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Telephone | 714-659-1969
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | TAP11637
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License Number State | AZ
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