Provider Demographics
NPI:1023449915
Name:MEDRANO, GAIL LOIS (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:LOIS
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 E TAHQUITZ CANYON WAY
Mailing Address - Street 2:#4-147
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-7020
Mailing Address - Country:US
Mailing Address - Phone:760-835-3590
Mailing Address - Fax:760-322-9719
Practice Address - Street 1:2145 E TAHQUITZ CANYON WAY
Practice Address - Street 2:#4-147
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-7020
Practice Address - Country:US
Practice Address - Phone:760-835-3590
Practice Address - Fax:760-322-9719
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP481124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist