MEDICARE: MS. JANEL LYNETTE MEDINA LCSW

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	1041C0700X	Clinical Social Worker	LCS24605	CA

General Provider Information

NPI Number	:	1699840579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANEL LYNETTE MEDINA LCSW

Provider Business Mailing Address
First Line	:	3420 KENYON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5001
Country	:	US
Telephone Number	:	619-221-6550
Fax Number	:	619-221-6556

Provider Business Practice Location Address
First Line	:	3420 KENYON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5001
Country	:	US
Telephone Number	:	619-221-6550
Fax Number	:	619-221-6556

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

Provider Enumeration Date	:	11/23/2006
Last Update Date	:	11/29/2021

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