Healthcare Provider Details

I. General information

NPI: 1841185451
Provider Name (Legal Business Name): JENNIFER LOPEZ MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13285 W HWY 152
DOS PALOS CA
93620-0008
US

IV. Provider business mailing address

13285 W HWY 152
DOS PALOS CA
93620-0008
US

V. Phone/Fax

Practice location:
  • Phone: 209-737-5213
  • Fax:
Mailing address:
  • Phone: 209-737-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: