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General NPI Number Information
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NPI Number | 1568050029
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Entity Type | Individual
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Provider Name | ANA A CODIZ MEDINA
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Gender | Female
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Dates
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Enumeration Date | 01/08/2021
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 2200 HARBOR BLVD STE B210
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City | COSTA MESA
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State | CA
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Zip | 92627-5890
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Country | US
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Telephone | 949-548-2273
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Fax | 949-548-4504
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Provider Business Mailing Address
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Address Line | 4201 W 5TH ST APT 105
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City | SANTA ANA
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State | CA
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Zip | 92703-3215
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Country | US
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Telephone | 714-292-3071
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95016322
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License Number State | CA
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