MEDICARE: ANGELA DE LOS SANTOS 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	172V00000X	Community Health Worker		CA

General Provider Information

NPI Number	:	1932042843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DE LOS SANTOS MEDINA

Provider Business Mailing Address
First Line	:	5926 MANZANITA AVE
Second Line	:	#321
City	:	ANGELUS OAKS
State	:	CA
Zip	:	92305-9501
Country	:	US
Telephone Number	:	951-972-3022
Fax Number	:	951-972-3022

Provider Business Practice Location Address
First Line	:	5926 MANZANITA AVE
Second Line	:	#321
City	:	ANGELUS OAKS
State	:	CA
Zip	:	92305-9501
Country	:	US
Telephone Number	:	951-972-3022
Fax Number	:	951-972-3022

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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