Healthcare Provider Details

I. General information

NPI: 1225568298
Provider Name (Legal Business Name): RAY MIGUEL MEDINA ASSOCIATES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 PAINTER AVE STE 201
WHITTIER CA
90602-3166
US

IV. Provider business mailing address

8313 WASHINGTON AVE
WHITTIER CA
90602-3022
US

V. Phone/Fax

Practice location:
  • Phone: 562-698-6600
  • Fax:
Mailing address:
  • Phone: 562-686-7348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: