Individual
ELLYN MEDRANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
8016 PETROGLYPH AVE NW, ALBUQUERQUE, NM 87120-6558
(505) 228-5050
(505) 214-5009
Mailing address
8016 PETROGLYPH AVE NW, ALBUQUERQUE, NM 87120-6558
(505) 228-5050
(505) 214-5009
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
3813
NM
Other
Enumeration date
10/09/2017
Last updated
10/09/2017
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