Healthcare Provider Details

I. General information

NPI: 1457515165
Provider Name (Legal Business Name): MEDINA BAUMGART PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 02/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BAUCHET ST ATTN: L.A. COUNTY DMH, JAIL MENTAL HEALTH SERVICES
LOS ANGELES CA
90012-2907
US

IV. Provider business mailing address

450 BAUCHET ST ATTN: DEPT OF MENTAL HEALTH - JAIL MH SERVICES
LOS ANGELES CA
90012-2907
US

V. Phone/Fax

Practice location:
  • Phone: 213-473-2920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: