Provider Demographics
NPI:1578776225
Name:MEDINA, ADRIAN RONALDO (LMFT)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:RONALDO
Last Name:MEDINA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1754 TECHNOLOGY DR STE 133
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-1320
Mailing Address - Country:US
Mailing Address - Phone:408-582-2121
Mailing Address - Fax:408-557-8086
Practice Address - Street 1:1754 TECHNOLOGY DR STE 133
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-1320
Practice Address - Country:US
Practice Address - Phone:408-582-2121
Practice Address - Fax:408-557-8086
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 30726106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist