Provider Demographics
NPI:1578226734
Name:MEDINA, MARGARITA ROSARIO
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:ROSARIO
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 1:1423 S SYCAMORE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-1725
Mailing Address - Country:US
Mailing Address - Phone:702-527-0133
Mailing Address - Fax:
Practice Address - Street 1:1423 S SYCAMORE ST APT 1
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-1725
Practice Address - Country:US
Practice Address - Phone:702-527-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY5098915OtherN/A