Provider Demographics
NPI:1225568298
Name:MEDINA, RAY MIGUEL (ASSOCIATES)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:MIGUEL
Last Name:MEDINA
Suffix:
Gender:M
Credentials:ASSOCIATES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8313 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3022
Mailing Address - Country:US
Mailing Address - Phone:562-686-7348
Mailing Address - Fax:
Practice Address - Street 1:8135 PAINTER AVE STE 201
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3166
Practice Address - Country:US
Practice Address - Phone:562-698-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician