Provider Demographics
NPI:1487530788
Name:MEDRANO, LUIS (OTR/L)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:MEDRANO
Suffix:
Gender:M
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 1:1203 FLYNN RD UNIT 160
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-6203
Mailing Address - Country:US
Mailing Address - Phone:805-804-4168
Mailing Address - Fax:805-830-1177
Practice Address - Street 1:1855 COCHRAN ST STE 109
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2265
Practice Address - Country:US
Practice Address - Phone:805-526-2311
Practice Address - Fax:805-526-6608
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27954225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist