Healthcare Provider Details

I. General information

NPI: 1538615851
Provider Name (Legal Business Name): ZAIRA GUADALUPE MEDINA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HILLMONT AVE
VENTURA CA
93003-1651
US

IV. Provider business mailing address

24736 SPRUCE ST
NEWHALL CA
91321-1708
US

V. Phone/Fax

Practice location:
  • Phone: 805-233-7750
  • Fax: 805-653-5974
Mailing address:
  • Phone: 661-644-7520
  • Fax: 805-655-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN682493
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: