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General NPI Number Information
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NPI Number | 1598617664
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Entity Type | Individual
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Provider Name | EVELYN MEDINA
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Gender | Female
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 1891 EFFIE ST
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City | LOS ANGELES
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State | CA
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Zip | 90026-1711
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Country | US
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Telephone | 213-342-5168
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Fax |
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Provider Business Mailing Address
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Address Line | 665 W SIERRA MADRE BLVD APT 22
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City | SIERRA MADRE
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State | CA
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Zip | 91024-2284
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Country | US
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Telephone | 626-485-6330
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | CA
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