Provider Demographics
NPI:1386995975
Name:MEDRANO, CLARISSA ARGUELLES (OTR/L)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:ARGUELLES
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6716 CRUCERO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3022
Mailing Address - Country:US
Mailing Address - Phone:915-342-3360
Mailing Address - Fax:
Practice Address - Street 1:406 CHELSEA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-1708
Practice Address - Country:US
Practice Address - Phone:915-307-7612
Practice Address - Fax:915-307-7619
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 174400000X
TX120812225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No172V00000XOther Service ProvidersCommunity Health Worker
No174400000XOther Service ProvidersSpecialist