Healthcare Provider Details

I. General information

NPI: 1104739234
Provider Name (Legal Business Name): JUNE MEDINA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 3RD AVE
SAN DIEGO CA
92103-1407
US

IV. Provider business mailing address

1413 STANCREST LN
NATIONAL CITY CA
91950-5135
US

V. Phone/Fax

Practice location:
  • Phone: 619-876-4502
  • Fax:
Mailing address:
  • Phone: 619-962-0319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number738707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: