Provider Demographics
NPI:1548607260
Name:MEDINA, ARIANA
Entity Type:Individual
Prefix:MS
First Name:ARIANA
Middle Name:
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 11867
Mailing Address - Street 2:CORRECTIONAL HEALTH
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-9352
Mailing Address - Fax:559-600-7687
Practice Address - Street 1:1225 M ST
Practice Address - Street 2:CORRECTIONAL HEALTH, 2ND FL
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1805
Practice Address - Country:US
Practice Address - Phone:559-600-9352
Practice Address - Fax:559-445-5277
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36717167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician