Provider Demographics
NPI:1568050029
Name:CODIZ MEDINA, ANA A
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:A
Last Name:CODIZ 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 1:4201 W 5TH ST APT 105
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3215
Mailing Address - Country:US
Mailing Address - Phone:714-292-3071
Mailing Address - Fax:
Practice Address - Street 1:2200 HARBOR BLVD STE B210
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5890
Practice Address - Country:US
Practice Address - Phone:949-548-2273
Practice Address - Fax:949-548-4504
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner