MEDICARE: MISS ENRIKA MEDINA ASUNCION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		CA

General Provider Information

NPI Number	:	1104547884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ENRIKA MEDINA ASUNCION

Provider Business Mailing Address
First Line	:	4276 KATELLA AVE # 210
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3562
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17330 NEWHOPE ST STE A
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4225
Country	:	US
Telephone Number	:	949-539-0865
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2022
Last Update Date	:	01/20/2026

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