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NPI Code Detail

MEDICARE: EVELYN MEDINA

MEDICARE: EVELYN MEDINA
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1306692371
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN MEDINA
Provider Business Mailing Address
First Line : 1274 CENTER COURT DR STE 211
Second Line :
City : COVINA
State : CA
Zip : 91724-3668
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2121 W TEMPLE ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-4915
Country : US
Telephone Number : 213-385-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2024
Last Update Date : 12/11/2025

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Directions to “ EVELYN MEDINA ” Practice Location

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