Healthcare Provider Details

I. General information

NPI: 1922580430
Provider Name (Legal Business Name): LAURA YESENIA MEDINA M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date: 07/14/2026
Reactivation Date: 08/26/2026

III. Provider practice location address

12628 FOXLEY DR
WHITTIER CA
90602-3417
US

IV. Provider business mailing address

12628 FOXLEY DR
WHITTIER CA
90602-3417
US

V. Phone/Fax

Practice location:
  • Phone: 562-964-9134
  • Fax:
Mailing address:
  • Phone: 562-964-9134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: