Healthcare Provider Details

I. General information

NPI: 1912463613
Provider Name (Legal Business Name): REBECCA MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 MOTOR AVE STE 110
LOS ANGELES CA
90034-3766
US

IV. Provider business mailing address

119 W TORRANCE BLVD STE 100
REDONDO BEACH CA
90277-3600
US

V. Phone/Fax

Practice location:
  • Phone: 424-212-6700
  • Fax: 424-212-6819
Mailing address:
  • Phone: 310-374-3300
  • Fax: 310-374-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: