Healthcare Provider Details

I. General information

NPI: 1245998855
Provider Name (Legal Business Name): DENISE MEDINA LMFT 153668
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 S EASTERN AVE STE 500
COMMERCE CA
90040-4033
US

IV. Provider business mailing address

5800 S EASTERN AVE STE 500
COMMERCE CA
90040-4033
US

V. Phone/Fax

Practice location:
  • Phone: 714-623-9171
  • Fax:
Mailing address:
  • Phone: 714-623-9171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT153668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: