MEDICARE: MINERVA MEDRANO MD

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	207Q00000X	Family Medicine Physician	RS2014-0575	NM
2	207Q00000X	Family Medicine Physician	MD2017-0246	NM
3	207Q00000X	Family Medicine Physician	S9184	TX

General Provider Information

NPI Number	:	1528474319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINERVA MEDRANO MD

Provider Business Mailing Address
First Line	:	1550 N ZARAGOZA RD # A-107
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7905
Country	:	US
Telephone Number	:	915-500-1100
Fax Number	:	915-440-3318

Provider Business Practice Location Address
First Line	:	1550 N ZARAGOZA RD STE 107
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7905
Country	:	US
Telephone Number	:	915-500-1100
Fax Number	:	833-913-2385

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

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	04/09/2025

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Directions to “ MINERVA MEDRANO MD” Practice Location

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