Provider Demographics
NPI:1467221127
Name:MEDINA, MAYRA (DOULA)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:MEDINA
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 S CENTINELA AVE APT C
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-6251
Mailing Address - Country:US
Mailing Address - Phone:310-699-2805
Mailing Address - Fax:
Practice Address - Street 1:4416 S CENTINELA AVE APT C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6251
Practice Address - Country:US
Practice Address - Phone:310-699-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula