MEDICARE: CRISTINA MEDRANO-ENRIQUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC-8027	ID

General Provider Information

NPI Number	:	1033991559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA MEDRANO-ENRIQUEZ

Provider Business Mailing Address
First Line	:	190 E BANNOCK ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83712-6241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 W MYRTLE ST STE 200
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-6975
Country	:	US
Telephone Number	:	208-706-6375
Fax Number	:	208-706-6395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	10/31/2025

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