Healthcare Provider Details

I. General information

NPI: 1710725627
Provider Name (Legal Business Name): NATALIE MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 W ORANGEWOOD AVE STE 110
ORANGE CA
92868-5056
US

IV. Provider business mailing address

12395 LEWIS ST STE 102
GARDEN GROVE CA
92840-4698
US

V. Phone/Fax

Practice location:
  • Phone: 714-696-2862
  • Fax:
Mailing address:
  • Phone: 760-634-1125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: