Provider Demographics
NPI:1588807614
Name:MEDELLIN, ALMA VERENICE
Entity Type:Individual
Prefix:
First Name:ALMA
Middle Name:VERENICE
Last Name:MEDELLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALMA
Other - Middle Name:VERENICE
Other - Last Name:SAUCEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1124 BAY BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-7155
Mailing Address - Country:US
Mailing Address - Phone:619-420-2930
Mailing Address - Fax:619-420-8722
Practice Address - Street 1:1124 BAY BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-7155
Practice Address - Country:US
Practice Address - Phone:619-420-2930
Practice Address - Fax:619-420-8722
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator