Healthcare Provider Details

I. General information

NPI: 1477419794
Provider Name (Legal Business Name): VERONICA ORALIA MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9265 SKY PARK CT STE 100
SAN DIEGO CA
92123-4375
US

IV. Provider business mailing address

2340 PICNIC CT
CHULA VISTA CA
91915-1813
US

V. Phone/Fax

Practice location:
  • Phone: 858-355-9258
  • Fax: 858-355-9258
Mailing address:
  • Phone:
  • Fax: 858-355-9258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95037878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: