Provider Demographics
NPI:1578842597
Name:MEDINA, NATASHA GUADALUPE
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:GUADALUPE
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 1:10012 NORWALK BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3343
Mailing Address - Country:US
Mailing Address - Phone:562-941-2537
Mailing Address - Fax:
Practice Address - Street 1:10012 NORWALK BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3343
Practice Address - Country:US
Practice Address - Phone:562-941-2537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator