Healthcare Provider Details

I. General information

NPI: 1194556902
Provider Name (Legal Business Name): MARLENE MELISSA MEDINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIDGES TO WELLNESS, 801 GATEWAY BLVD STE 100
SOUTH SAN FRANCISCO CA
94080-7408
US

IV. Provider business mailing address

BRIDGES TO WELLNESS, 801 GATEWAY BLVD STE 100
SOUTH SAN FRANCISCO CA
94080-7408
US

V. Phone/Fax

Practice location:
  • Phone: 650-573-4799
  • Fax:
Mailing address:
  • Phone: 650-573-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: