Provider Demographics
NPI:1043847015
Name:AMODIO MEDINA, DANIELA CAROLINA DE LAS M (MD)
Entity Type:Individual
Prefix:
First Name:DANIELA
Middle Name:CAROLINA DE LAS M
Last Name:AMODIO MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:7800 NILES ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4922
Practice Address - Country:US
Practice Address - Phone:661-328-4284
Practice Address - Fax:661-616-9977
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTL2499390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program