Provider Demographics
NPI:1902257835
Name:MEDRANO, FELIPE (COTA)
Entity Type:Individual
Prefix:
First Name:FELIPE
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 N HUALAPAI WAY
Mailing Address - Street 2:2057
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8049
Mailing Address - Country:US
Mailing Address - Phone:720-934-1647
Mailing Address - Fax:
Practice Address - Street 1:5538 DUNCAN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2812
Practice Address - Country:US
Practice Address - Phone:702-645-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16-1321224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant