Provider Demographics
NPI:1407912876
Name:MEDINA, NYDIA MARITZA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:MARITZA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8371 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4406
Mailing Address - Country:US
Mailing Address - Phone:408-848-2999
Mailing Address - Fax:408-848-3354
Practice Address - Street 1:8371 CHURCH ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4406
Practice Address - Country:US
Practice Address - Phone:408-848-2999
Practice Address - Fax:408-848-3354
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20267103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical