MEDICARE: MARLYN E MEDINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	171M00000X	Case Manager/Care Coordinator
3	390200000X	Student in an Organized Health Care Education/Training Program		CA
4	101YM0800X	Mental Health Counselor		CA
5	1041C0700X	Clinical Social Worker	135067	CA

General Provider Information

NPI Number	:	1457607764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLYN E MEDINA

Provider Business Mailing Address
First Line	:	12730 MUSCATINE ST
Second Line	:
City	:	ARLETA
State	:	CA
Zip	:	91331-4243
Country	:	US
Telephone Number	:	818-815-8680
Fax Number	:

Provider Business Practice Location Address
First Line	:	15305 RAYEN ST
Second Line	:
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-5117
Country	:	US
Telephone Number	:	818-892-3423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	03/10/2026

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Directions to “ MARLYN E MEDINA ” Practice Location

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