Provider Demographics
NPI:1437912250
Name:MEDINA, CRISTINA AMELIA
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:AMELIA
Last Name:MEDINA
Suffix:
Gender:F
Credentials:
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 2905
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-0055
Mailing Address - Country:US
Mailing Address - Phone:909-265-1081
Mailing Address - Fax:
Practice Address - Street 1:9127 DOVER RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5617
Practice Address - Country:US
Practice Address - Phone:909-265-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula