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NPI Code Detail

MEDICARE: MS. SANDRA ANGELICA MEDINA

MEDICARE: MS. SANDRA ANGELICA 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
1171M00000XCase Manager/Care Coordinator
2167G00000XLicensed Psychiatric Technician40294CA

General Provider Information

NPI Number : 1871795823
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SANDRA ANGELICA MEDINA
Provider Business Mailing Address
First Line : 250 N HAMBLEDON AVE
Second Line :
City : LA PUENTE
State : CA
Zip : 91744-5323
Country : US
Telephone Number : 626-581-8684
Fax Number :
Provider Business Practice Location Address
First Line : 2900 E DEL MAR BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-4375
Country : US
Telephone Number : 626-795-9901
Fax Number : 626-356-2503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2007
Last Update Date : 02/08/2019

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Directions to “ MS. SANDRA ANGELICA MEDINA ” Practice Location

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