Healthcare Provider Details

I. General information

NPI: 1306614896
Provider Name (Legal Business Name): MISS VICTORIA CATHERINE MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14135 MAIN ST STE 301
HESPERIA CA
92345-8095
US

IV. Provider business mailing address

14135 MAIN ST STE 301
HESPERIA CA
92345-8095
US

V. Phone/Fax

Practice location:
  • Phone: 866-205-3595
  • Fax:
Mailing address:
  • Phone: 866-205-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number122926
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: