Healthcare Provider Details

I. General information

NPI: 1881153963
Provider Name (Legal Business Name): RUBELETA MEDINA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RUBELETA VELANDO SARMIENTO FNP-C

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date: 04/10/2019
Reactivation Date: 08/11/2022

III. Provider practice location address

9995 CARMEL MOUNTAIN RD STE B10-11
SAN DIEGO CA
92129-2889
US

IV. Provider business mailing address

637 3RD AVE STE E1 UNIT 78
CHULA VISTA CA
91910-5707
US

V. Phone/Fax

Practice location:
  • Phone: 844-200-2426
  • Fax: 858-240-6470
Mailing address:
  • Phone: 844-200-2426
  • Fax: 619-356-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011111
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95011111
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number751801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: