Healthcare Provider Details

I. General information

NPI: 1053251785
Provider Name (Legal Business Name): NATANAEL MEDINA GONZALEZ CHW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7344 MAGNOLIA AVE STE 110
RIVERSIDE CA
92504-3819
US

IV. Provider business mailing address

7344 MAGNOLIA AVE STE 110
RIVERSIDE CA
92504-3819
US

V. Phone/Fax

Practice location:
  • Phone: 951-934-8183
  • Fax: 951-934-8183
Mailing address:
  • Phone: 951-934-8183
  • Fax: 951-934-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: