Healthcare Provider Details

I. General information

NPI: 1245165307
Provider Name (Legal Business Name): GABRIEL ALEXANDER MEDINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 S CENTRAL ST
VISALIA CA
93277-4417
US

IV. Provider business mailing address

6117 W LAURA AVE
VISALIA CA
93277-5558
US

V. Phone/Fax

Practice location:
  • Phone: 559-372-7002
  • Fax: 559-697-4648
Mailing address:
  • Phone: 559-583-9300
  • Fax: 559-583-9307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: