Healthcare Provider Details

I. General information

NPI: 1881164234
Provider Name (Legal Business Name): EVETTE MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 BLANCO CIR
SALINAS CA
93901-4401
US

IV. Provider business mailing address

913 BLANCO CIR
SALINAS CA
93901-4401
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-6655
  • Fax: 831-424-9717
Mailing address:
  • Phone: 831-424-6655
  • Fax: 831-424-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: