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General NPI Number Information
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NPI Number | 1730396128
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Entity Type | Organization
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Legal Business Name | ALMA M MEDINA
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2076 VESTAL CT
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City | SAN LEANDRO
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State | CA
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Zip | 94577-2328
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Country | US
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Telephone | 650-455-2574
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Fax |
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Provider Business Mailing Address
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Address Line | 2076 VESTAL CT
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City | SAN LEANDRO
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State | CA
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Zip | 94577-2328
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Country | US
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Telephone | 650-455-2574
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MRS. ALMA M MEDINA
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Credential |
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Telephone | 650-455-2574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | CA
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