Healthcare Provider Details

I. General information

NPI: 1619812849
Provider Name (Legal Business Name): STEVEN A MEDINA AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41593 WINCHESTER RD STE 215
TEMECULA CA
92590-4841
US

IV. Provider business mailing address

22400 BARTON RD SUITE #21 PMB #498
GRAND TERRACE CA
92313-5069
US

V. Phone/Fax

Practice location:
  • Phone: 951-602-7730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: