Provider Demographics
NPI:1346853512
Name:MEDINA, KAILANI (APCC)
Entity Type:Individual
Prefix:MS
First Name:KAILANI
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20101 SW BIRCH ST STE 240
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1769
Mailing Address - Country:US
Mailing Address - Phone:619-384-0860
Mailing Address - Fax:
Practice Address - Street 1:20101 SW BIRCH ST STE 240
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1769
Practice Address - Country:US
Practice Address - Phone:619-384-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional