Healthcare Provider Details

I. General information

NPI: 1386562635
Provider Name (Legal Business Name): DARLA RAE MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 BUENA VISTA AVE W
SAN FRANCISCO CA
94117-4108
US

IV. Provider business mailing address

815 BUENA VISTA AVE W
SAN FRANCISCO CA
94117-4108
US

V. Phone/Fax

Practice location:
  • Phone: 415-554-1450
  • Fax:
Mailing address:
  • Phone: 415-554-1450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: