Provider Demographics
NPI:1568691657
Name:MEDINA, MARIANELLA
Entity Type:Individual
Prefix:MS
First Name:MARIANELLA
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 1:22215 KINNEY ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-7918
Mailing Address - Country:US
Mailing Address - Phone:951-943-7753
Mailing Address - Fax:
Practice Address - Street 1:10182 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5304
Practice Address - Country:US
Practice Address - Phone:951-509-2400
Practice Address - Fax:951-509-2405
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor