Healthcare Provider Details

I. General information

NPI: 1851275952
Provider Name (Legal Business Name): JANICE MEDINA CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9434 MEDICAL CENTER DR
LA JOLLA CA
92037-1337
US

IV. Provider business mailing address

1429 MYRTLE AVE
SAN DIEGO CA
92103-5116
US

V. Phone/Fax

Practice location:
  • Phone: 858-249-2975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number5215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: