Individual
JACK MEDRANO MEJIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
446 ALTA RD, SAN DIEGO, CA 92158-0001
(619) 661-2789
(619) 661-2797
Mailing address
5530 OVERLAND AVE, SAN DIEGO, CA 92123-1260
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
702870
CA
Other
Enumeration date
08/12/2020
Last updated
08/12/2020
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