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General NPI Number Information
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NPI Number | 1003302662
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Entity Type | Individual
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Provider Name | MR. OMAR A MEDINA I
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Gender | Male
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Dates
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Enumeration Date | 07/06/2018
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Last Update Date | 07/06/2018
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Provider Practice Location Address
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Address Line | 12411 SLAUSON AVE STE H
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City | WHITTIER
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State | CA
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Zip | 90606-2835
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Country | US
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Telephone | 562-693-5449
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Fax |
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Provider Business Mailing Address
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Address Line | 666 BRADSHAWE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90022-3403
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Country | US
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Telephone | 909-542-5204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 4213
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License Number State | CA
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