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General NPI Number Information
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NPI Number | 1205709664
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Entity Type | Individual
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Provider Name | JOSHUA MEDINA
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Gender | Male
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 3002 DOW AVE STE 318
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City | TUSTIN
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State | CA
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Zip | 92780-7234
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Country | US
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Telephone | 714-389-9306
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 N REDDING WAY
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City | UPLAND
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State | CA
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Zip | 91784-8219
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 308680
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License Number State | CA
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