Provider Demographics
NPI:1619512241
Name:MEDINA-HERNANDEZ, DALHIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:DALHIA
Middle Name:
Last Name:MEDINA-HERNANDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:DALHIA
Other - Middle Name:
Other - Last Name:MEDINA-HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS-RBT
Mailing Address - Street 1:2141 PALOMAR AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1423
Mailing Address - Country:US
Mailing Address - Phone:760-438-0078
Mailing Address - Fax:
Practice Address - Street 1:2141 PALOMAR AIRPORT RD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1423
Practice Address - Country:US
Practice Address - Phone:760-438-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician