Provider Demographics
NPI:1194413740
Name:MEDRANO PEDIATRIC GROUP PLLC
Entity type:Organization
Organization Name:MEDRANO PEDIATRIC GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-973-5024
Mailing Address - Street 1:415 S AIRPORT DR STE E
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5396
Mailing Address - Country:US
Mailing Address - Phone:956-973-5024
Mailing Address - Fax:956-973-5064
Practice Address - Street 1:415 S AIRPORT DR STE E
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5396
Practice Address - Country:US
Practice Address - Phone:956-973-5024
Practice Address - Fax:956-973-5064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty