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General NPI Number Information
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NPI Number | 1316620651
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Entity Type | Individual
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Provider Name | AYSELL MEDINA
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 9300 CAMPUS POINT DR
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City | LA JOLLA
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State | CA
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Zip | 92037-1300
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Country | US
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Telephone | 562-743-7025
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Fax |
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Provider Business Mailing Address
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Address Line | 3392 DALEY CENTER DR APT 205
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City | SAN DIEGO
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State | CA
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Zip | 92123-4604
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH88246
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License Number State | CA
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