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NPI Code Detail

MEDICARE: DAYLENE ALEXUS MEDINA MSW, ACSW

MEDICARE: DAYLENE ALEXUS MEDINA MSW, ACSW
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
11041C0700XClinical Social Worker132191CA

General Provider Information

NPI Number : 1578446100
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAYLENE ALEXUS MEDINA MSW, ACSW
Provider Business Mailing Address
First Line : PO BOX 1832
Second Line :
City : COLTON
State : CA
Zip : 92324-0808
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4624 ARLINGTON AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92504-2702
Country : US
Telephone Number : 951-732-8568
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2025
Last Update Date : 08/26/2025

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