MEDICARE: JOSE JAVIER MEDINA JR. MA, LMFT

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	106H00000X	Marriage & Family Therapist	124026	CA

General Provider Information

NPI Number	:	1922519487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE JAVIER MEDINA JR. MA, LMFT

Provider Business Mailing Address
First Line	:	1905 N SHERMAN ST STE 2001400
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1140
Country	:	US
Telephone Number	:	408-634-5971
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 N SHERMAN ST STE 2001400
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1140
Country	:	US
Telephone Number	:	408-634-5971
Fax Number	:

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

Provider Enumeration Date	:	10/23/2017
Last Update Date	:	07/30/2024

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