Provider Demographics
NPI:1386183382
Name:NATALIE MEDINA, MD, INC
Entity Type:Organization
Organization Name:NATALIE MEDINA, MD, INC
Other - Org Name:NATALIE J. MEDINA, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-995-0990
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91908-1404
Mailing Address - Country:US
Mailing Address - Phone:619-267-1168
Mailing Address - Fax:619-267-6644
Practice Address - Street 1:502 EUCLID AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2931
Practice Address - Country:US
Practice Address - Phone:619-267-1168
Practice Address - Fax:619-267-6644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATALIE MEDINA, MD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54817261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB258847Medicare UPIN