Healthcare Provider Details

I. General information

NPI: 1669929246
Provider Name (Legal Business Name): ADRIAN MICHAEL MEDINA CNM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 11/02/2025
Certification Date: 11/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 E FIR AVE
FRESNO CA
93720-0536
US

IV. Provider business mailing address

PO BOX 889442
LOS ANGELES CA
90088-9442
US

V. Phone/Fax

Practice location:
  • Phone: 559-881-6151
  • Fax: 559-261-9324
Mailing address:
  • Phone: 559-603-7389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: