Healthcare Provider Details

I. General information

NPI: 1427961473
Provider Name (Legal Business Name): ADAM JACOB MEDINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N DEWITT AVE
CLOVIS CA
93612-1066
US

IV. Provider business mailing address

2272 E PALO ALTO AVE
FRESNO CA
93710-4535
US

V. Phone/Fax

Practice location:
  • Phone: 559-420-3852
  • Fax:
Mailing address:
  • Phone: 559-753-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: