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
1	171M00000X	Case Manager/Care Coordinator		CA

General Provider Information

NPI Number	:	1598617664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN MEDINA

Provider Business Mailing Address
First Line	:	665 W SIERRA MADRE BLVD APT 22
Second Line	:
City	:	SIERRA MADRE
State	:	CA
Zip	:	91024-2284
Country	:	US
Telephone Number	:	626-485-6330
Fax Number	:

Provider Business Practice Location Address
First Line	:	1891 EFFIE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-1711
Country	:	US
Telephone Number	:	213-342-5168
Fax Number	:

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

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “ EVELYN MEDINA ” Practice Location

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