Provider Demographics
NPI:1558751891
Name:MEDINA, YULIANA ALVAREZ (ASW)
Entity Type:Individual
Prefix:
First Name:YULIANA
Middle Name:ALVAREZ
Last Name:MEDINA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9633 SHADE LN
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-5315
Mailing Address - Country:US
Mailing Address - Phone:713-894-0295
Mailing Address - Fax:
Practice Address - Street 1:14075 HESPERIA RD STE 101
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4500
Practice Address - Country:US
Practice Address - Phone:760-810-0000
Practice Address - Fax:760-810-0178
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW61692101YM0800X
CALCSW810301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health