Healthcare Provider Details

I. General information

NPI: 1285538256
Provider Name (Legal Business Name): BIANCA MEDINA MARRIAGE AND FAMILY THERAPY, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1107 E 3RD ST APT 7
LONG BEACH CA
90802-3586
US

IV. Provider business mailing address

1107 E 3RD ST APT 7
LONG BEACH CA
90802-3586
US

V. Phone/Fax

Practice location:
  • Phone: 213-265-0997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: BIANCA MEDINA
Title or Position: PRESIDENT
Credential: LMFT, LPCC
Phone: 213-640-6088