Provider Demographics
NPI:1528482031
Name:MEDRANO, DANAE MICHELLE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:DANAE
Middle Name:MICHELLE
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN BAUTISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95045-0753
Mailing Address - Country:US
Mailing Address - Phone:831-245-5280
Mailing Address - Fax:
Practice Address - Street 1:7500 ARROYO CIR STE 180
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7339
Practice Address - Country:US
Practice Address - Phone:408-842-8328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-20-44954103K00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst