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General NPI Number Information
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NPI Number | 1972749216
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Entity Type | Organization
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Legal Business Name | CELERINA B MEDINA MD INC
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Dates
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Enumeration Date | 12/16/2008
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 4149 TWEEDY BLVD SUITE B
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City | SOUTH GATE
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State | CA
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Zip | 90280-6167
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Country | US
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Telephone | 323-564-4545
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Fax | 323-564-3063
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Provider Business Mailing Address
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Address Line | 4149 TWEEDY BLVD SUITE B
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City | SOUTH GATE
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State | CA
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Zip | 90280-6167
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Country | US
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Telephone | 323-564-4545
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Fax | 323-564-3063
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CELERINA MEDINA
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Credential | M.D.
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Telephone | 323-564-4545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A45547
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License Number State | CA
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