Provider Demographics
NPI:1154519932
Name:MEDRANO, SERGIO RUBEN (PA)
Entity type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:RUBEN
Last Name:MEDRANO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:7200 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1200
Mailing Address - Country:US
Mailing Address - Phone:305-500-2009
Mailing Address - Fax:305-500-2145
Practice Address - Street 1:11865 SW 26TH ST # A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2400
Practice Address - Country:US
Practice Address - Phone:305-500-2009
Practice Address - Fax:305-500-2145
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9101126363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant