Healthcare Provider Details

I. General information

NPI: 1033123849
Provider Name (Legal Business Name): ADOLFO JORGE MEDINA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AL MEDINA M.S, LMFT

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5978 GREENWOOD CMN
LIVERMORE CA
94550-4798
US

IV. Provider business mailing address

5978 GREENWOOD CMN
LIVERMORE CA
94550-4798
US

V. Phone/Fax

Practice location:
  • Phone: 925-518-9168
  • Fax: 925-373-6654
Mailing address:
  • Phone: 925-373-6654
  • Fax: 925-373-6654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35047
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC35047
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberMFC35047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: